Oral and maxillofacial surgeons are trained, skilled and uniquely qualified to manage and treat many aspects 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. Oral and maxillofacial surgeons are well versed in emergency care, acute treatment and also long-term reconstruction and rehabilitation.
Dr Bowler was a Senior V.M.O. Oral and Maxillofacial Surgeon with the Hunter Area Health Service for 30 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:
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, such as motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. Types of facial injuries can range from injuries to teeth to extremely severe injuries to 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 usually 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. Dr. Bowler is a well-trained oral and maxillofacial surgeon and is proficient at diagnosing and treating many types of facial lacerations but where necessary your treatment may also require the attendance and expertise of an experienced plastic and reconstructive surgeon.
Bone Injuries of the Maxillofacial Region
Fractures to the bones in the face are treated in a similar manner to 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. When an arm or leg is fractured a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.
Most types of fractures of the jaw are 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 eliminates the necessity of having the jaws wired together. This technique is called “rigid fixation” of a fracture. The development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly. Occasionally treatment may involve wiring the jaws together or using intermittent elastics for certain fractures of the upper and/or lower jaw
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 & Surrounding Dental Structures
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral and maxillofacial surgeons are usually involved in treating fractures in the supporting bone or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together).
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 chance it will survive. 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 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 often now utilized as permanent replacements for missing teeth.
The proper treatment of many facial injuries is frequently the realm of oral and maxillofacial surgeons who are well versed in emergency care, acute treatment, long-term reconstruction, and rehabilitation of the patient.
Case Study #1
Uncomplicated mandibular fracture at the left angle of the mandible in a 3rd molar site treated with internal plate fixation.
Left Angle Fracture
Plated Fracture: Single Miniplate
Case Study #2
Left sided orbital floor “blow out” fracture in a 64 year old female patient following a fall. Treated with an open exploration of the orbit and repaired using 0.2 mm titanium mesh sheeting to restore the anatomy.
Case Study #3
Left zygomatico-maxillary (ZMC) fracture resulting from an assault. Treated by open operation and miniplate fixation.
Case Study #4
Severe pan facial fractures in a 35 year old male following a high speed motor vehicle accident. Treated by open operation and multiple titanium mini plate/screw fixation to reconstruct the maxillofacial skeleton.