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Facial Fractures

Fractures to the upper or lower jaw bone, cheekbones, nose or eye sockets are a relatively frequent outcome of facial trauma, such as an auto accident, a sports injury, or a forceful blow. Fractures tend to happen in distinct areas of the bones of the face, and can basically be categorized based on the part of the face in which they occur.

The most common place for a facial fracture to occur is the mandible, or lower jaw. Even though a large amount of force is required to cause this bone to break, the prominence of the lower jaw makes it a common site for fractures. Mandibular fractures occur about twice as often as fractures to other bones in the face. Another area in the face in which fractures often occur is the area around the eye and the cheek. The bone that makes up the eye socket is called the "orbit," and the bone of the cheek is called the malar (or the zygomatic) bone. Fractures can also occur in the upper jaw, or maxilla.

Symptoms

The most frequent symptoms of a facial fracture are pain and tenderness, numbness, swelling or discoloration of the skin around the fracture, or visible deformity of the facial structure.

In cases of a broken nose or fracture on the middle area of the face, patients may experience difficulty swallowing or breathing, and the presence of blood or fluid in the nose.

In the case of fractures to the jaw bone or nearby areas, symptoms include an inability to open the mouth, changes in the alignment of the teeth and in the bite, and severe lacerations (cuts) near the gums.

Diagnosis

A fracture can be diagnosed with a close examination of the patient's face. The physician will feel along the bones of the face with his or her fingers to examine it for irregularities in the bone, and will also ask about the particular circumstances that led to the injury. The precise location, type and severity of a fracture can be diagnosed with an x-ray or a CT scan. Usually, images will be taken at different angles to get a full diagnostic picture of the fracture.

Treatment

The first step in treating facial trauma is to control the edema, or swelling, that often occurs. Swelling can lead to obstruction of airways, and can cause difficulty breathing. The face is elevated to allow blood to drain, ice may be applied, and analgesics may be given to control pain.

After that, treatment for facial fractures is similar to treatment of fractures elsewhere in the body in that it involves two steps: stabilization and fixation. Stabilization means setting of the bones, and fixation means immobilizing them so that they can grow back together properly. This process often requires surgery.

In cases of maxillary or mandibular fractures, fixation has traditionally involved wiring the two jaws shut with wires or rubber bands. However, when possible, physicians now use a method called "rigid fixation," in which tiny plates and screws are attached directly to the bones to hold them together. Such plates and screws are used for fixation of fractures elsewhere in the face as well, and have made recovery from facial fractures much easier.

The aim of treatment is to return the injured area to normal in terms of function as well as appearance.

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