Traumatic face injuries

Facial trauma is a condition with special characteristics unlike other types of fractures or traumatic injuries in the rest of the body.

Breaking the bones of the face can lead to both aesthetic and functional problems. Breaking the upper or lower jaw can change how the upper and lower teeth fit together (change in occlusion), which can lead to serious complications (difficulty chewing, pain, problems in the temporomandibular joint) if the fracture is not properly reduced, stabilised and healed.

Treatment and prevention of maxillofacial injuries, also referred to as facial trauma, covers all injuries of the mouth, face and jaw. Nearly everyone has been injured, or knows someone who has. Most maxillofacial injuries are caused by a sports accident, car accident, workplace accident, violence or accident at home.

If a person is unconscious, disoriented, nauseous, dizzy or otherwise incapacitated, call emergency services immediately. Do not try to move them. If they don’t have these symptoms but the injury is serious or you are unsure of how serious it is, take the person to the nearest emergency room as soon as possible.

Treating traumatic face injuries

One of the most common serious face injuries is due to broken bones. Fractures may involve the mandible, upper jaw, palate, cheekbones, eye sockets or combination of these bones. These injuries may affect a patient’s vision, ability to breathe, speak and swallow. Treatment often requires a hospital stay.

The principles behind treating facial fractures are the same as if you break a leg or an arm. The parts of the bone must be aligned (reduced) and held into position for long enough to allow them to heal. This can take six weeks or more, depending on the patient’s age and the complexity of the fracture.

The repositioning technique used by the oral and maxillofacial surgeon will depend on the location and seriousness of the fracture. If the upper or lower jaw is broken, for example, metal devices are used to keep the teeth in place and cork bands or cables are used to keep the jaws together. Patients with few or no teeth may need prostheses or splints built specially to align and set the fracture. Often patients with facial fractures have other medical problems as well. The oral and maxillofacial surgeon is qualified to coordinate their treatment with that of other doctors.

During the healing process, when the jaws are wired together, the oral and maxillofacial surgeon will prescribe a liquid diet that will help the healing process while keeping the patient healthy. After the patient has been discharged from the hospital, the doctor will give them instructions to continue with facial and oral care.

With complex or extensive maxillofacial fractures, multiple incisions are made to expose the bones and a combination of mesh or coating techniques may be necessary.

Never take any facial injury lightly

Although not all facial injuries are extensive, they are all complex as they affect a part of the body that is essential for breathing, eating, speaking and seeing. Even in the case of a moderate cut on the lip, the experience of an oral and maxillofacial surgeon is essential. If it is necessary to suture the injury, the location must be precise to ensure the proper aesthetic results. So, the golden rule is to not take any facial injury lightly.

Prevention – The best policy

As avoiding injury is always the best option, oral and maxillofacial surgeons advocate the use of safety belts in vehicles and mouthguards, masks and helmets when doing sport at any level. You don’t have to play professionally to be at risk of serious brain damage. Innovations in helmet and mouthguard technology have made these devices much more comfortable and effective in protecting vulnerable maxillofacial areas. Make sure your family is protected. If you do sport, make the following recommendations part of your standard sports equipment.

Helmets with faceguards and mouthguards must be used. Many helmets made specifically for young players have plastic faceguards that can cause serious face injuries. They should be replaced with carbon-steel mesh guards.
The catcher must always wear a mask. Batting helmets with a transparent plastic guard are available, which can also be used when fielding.
Many ice-hockey players are starting to use a face cage, as well as safety devices in their helmets. These are better than the hard-plastic masks used by some goal keepers, as the helmet and faceguard can bear the brunt of an impact to the face. For additional protection, mouthguards and faceguards -including hard-plastic external mouthguards attached with a strap- may be used.
Wrestlers must wear mouthguards. Special masks have also been developed recently for this purpose.
Mouthguards are obligatory in this sport. A new dummy-style mouthguard for boxers has been designed with a thicker front piece that has air holes to make it easier to breathe.
Hard-plastic helmets like those used for batting in baseball with mesh cage masks are made specifically for this sport.
Oral and maxillofacial surgeons recommend anyone participating in this sport wear a mouthguard. Goal keepers should have additional protection, wearing Lacrosse helmets.
Football players should wear mouthguards. Oral and maxillofacial surgeons also recommend goal keepers wear a helmet.
Riders should all wear a light motorcycle helmet to protect their heads. Scooters and skaters: those who travel on two wheels, scooters and skateboards should also wear a cycle helmet.
The recent increase in skiing and snowboarding accidents has led many safety-conscious snow lovers to wear light helmets to protect their maxillofacial area if they fall or have an accident.
It is strongly recommended that those riding horses wear a helmet and mouthguard, above all when jumping.
Water polo, handball, rugby, karate, judo and gymnastics: anyone who does these sports should wear a mouth guard.

A word on mouthguards

New synthetic materials and breakthroughs in engineering and design have led to lighter, more durable mouthguards that allow wearers to breathe easily. Mouthguards range from the affordable “boil and bite” type to those specially designed by dentists, which are sport-specific and generally more comfortable.

A mouthguard should be assessed in terms of comfort, fit, ability to speak and breathe, resistance to coming out and protection for teeth, gums and lips.

There are five things to take into account when choosing a mouthguard. The device should be:

  • Installed in a way that doesn’t jeopardise jaw alignment and comes off easily.

  • Light.

  • Strong.

  • Easy to clean.

  • Covering the incisal edge but not the gums.

In encouraging sports lovers at all levels to wear mouthguards and other protective equipment, oral and maxillofacial surgeons hope to change the “face” of sports.
In the case of a mouth or face injury that requires a visit to the emergency room, the injured athlete, their parents or trainer must be sure to request an oral and maxillofacial surgeon be called in to consult. With their experience and training, oral and maxillofacial surgeons are the most qualified to deal with this sort of injury. In some cases, this could also mean detecting “hidden” damage that wouldn’t otherwise be noticeable.

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  • Personal diagnosis after oral and facial exploration
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