There are a number of possible causes of facial trauma. Motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work-related injuries account for many. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face.
Typically, facial injuries are classified as soft-tissue injuries (skin and gums), bony injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).
Soft Tissue Injuries
When soft tissue injuries such as lacerations occur on the face, they are repaired by “suturing.” In addition to the obvious concern of providing a repair that yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands and salivary ducts (or outflow channels).
Fractures to the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, and the age and general health of the patient.
A broken arm or leg may be placed in a “cast” to stabilize the bone during healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.
One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. However, certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small “plates and screws” at the involved site.
This technique of treatment can often allow for healing and can make having the jaws wired together unnecessary. It is called “rigid fixation” of a fracture. The relatively recent development and use of “rigid fixation” has profoundly improved the recovery period for many patients by allowing them to return to normal function more quickly.
The treatment of facial fractures should be accomplished in a thorough and predictable manner. Importantly, the patient’s facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. At the same time, the incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is “hidden.”
Injuries to the Teeth and Surrounding Dental Structures
If a tooth is “knocked out,” it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better for the survival of the tooth. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to “wipe the tooth off,” since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth.
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists, such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.
The proper treatment of facial injuries will be recommended by Dr. Howard, as he is experienced in the emergency care, acute treatment and long- term reconstruction and rehabilitation.