Facial Trauma

Oral and maxillofacial surgeons are trained, skilled and uniquely qualified to manage and treat many aspect of facial trauma. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.

Dr Bowler has been a V.M.O. Oral and Maxillofacial Surgeon to the Hunter Area Health Service for over 20 years and has a significant amount of experience in the treatment of all aspects of maxillofacial trauma. Many of these patients have had motor vehicle accidents, assaults or other accidents. They are usually seen in a Casualty Department of one of the local hospitals but where appropriate some of these patients are referred to the practice.

Typical conditions seen are as follows:

• Facial lacerations
• Intra oral lacerations
• Avulsed (knocked out) teeth
• Fractured facial bones (cheek, nose or eye socket)
• Fractured jaws (upper and lower jaw)

The Nature of Maxillofacial Trauma:

There are a number of possible causes of facial trauma. Motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work related injuries. 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 either soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).

Soft Tissue Injuries of the Maxillofacial Region:

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). Dr. Bowler is a well trained oral and maxillofacial surgeon and is proficient at diagnosing and treating most types of facial lacerations. Certain types of extensive facial lacerations may need referral to a plastic and reconstructive surgeon and Dr. Bowler will arrange this where necessary.

Bone Injuries of the Maxillofacial Region:

The treatment of facial bone fractures these days is almost always done without the need to wire the jaws together or use external frames or devices. Rigid internal fixation is almost exclusively used to relocate the fractures into their correct anatomical position via cosmetically placed incisions. The use of rigid fixation has profoundly improved the recovery period for many patients allowing them to return to normal function quickly. Grafts of bone, fat, dermis etc. are on occasions required to allow a complete reconstruction of the traumatised tissues.

The treatment of facial fractures should be accomplished in a thorough and predictable manner. More 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:

Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral and maxillofacial surgeons usually are involved in treating fractures of the supporting bone or in replanting teeth that have been displaced or knocked out. Therefore, the patient should see a dentist or oral and maxillofacial surgeon as soon as possible. Never attempt to wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon 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 now utilised as replacements for missing teeth.

The proper treatment of facial injuries is the realm of specialists who are well versed in emergency care, acute treatment, long term reconstruction and rehabilitation of the patient.