Facial Fracture

A fracture is a broken bone. Facial fracture refers to any injury that results in a bone or bones of the face being broken.

Many situations can cause facial fractures. Motor vehicle crashes, sporting injuries, falls, and assaults account for the majority, although injuries from gunshot wounds and stabbings occur as well.

Always be concerned about other injuries with facial fractures. In particular, other parts of the body may be injured, for example, if a person has facial injuries in a motor vehicle accident, there may be other injuries.

A broken nose is any crack or fracture in the bony portion of the nose.

Although certain symptoms are specific to the bone fracture, some symptoms are common to any fractured bone. Remember that these symptoms may indicate a soft tissue injury (without a broken bone).

• Pain
• Swelling
• Bruising

Broken nose symptoms 

• Swelling
• Tenderness
• Deformity
• Nosebleed (if present, is usually minor)
• Significant trauma to the bridge of the nose may result in a fracture of the bones inside the nose (ethmoid bones).
• These bones, if fractured, may cause the brain to connect with the outside environment.
• Possible symptoms include persistent nosebleed or a clear nasal discharge.

Broken jaw symptoms

• Jaw pain
• Tenderness
• Inability to bring the teeth together properly (malocclusion)
• Bruising under the tongue almost always indicates a jaw fracture.

Midface (maxillary) fracture symptoms 

• Inability to bring the teeth together properly
• Visual problems
• Clear nasal discharge
• Bruising may be present around the eyes and the midface may be able to be moved.
• These fractures are not usually subtle and are often the result of high-speed car accidents. As a result, there might be a severe injury to areas other than the face.
• Many of these people will have difficulty breathing and require a tube to be placed down their throat to help them breathe.

Cheekbone (zygomatic) fracture symptoms

• The flatness of the cheek
• Altered sensation underneath the eye on the affected side
• Visual complaints
• Pain with jaw movement
• Blood in the side of the eye on the affected side sometimes is present.

Eye socket (orbital) fracture symptoms

• Sunken eye (enophthalmos)
• Altered sensation beneath the affected eye
• Double vision, particularly with an upward gaze
• This fracture involves the bones of the eye socket.
• The injury usually occurs when a blunt object hits the eye such as a fist or a ball.

Temporomandibular joint (TMJ) dislocation symptoms

• Jaw deviation
• Inability to close the mouth
• Dislocation of the TMJ (the joint where your jaw meets with the temporal bone, in front of the ear) can occur with blunt trauma, seizures, or excessive mouth opening.

A doctor should check all people with facial trauma and any significant facial injury. The affected individual can either see a doctor or go to the emergency department.

In the event of serious trauma, 911 should be called.

If a person experiences the following symptoms, seek medical attention.

• Difficulty breathing
• Clear nasal discharge
• Nosebleed
• Loss of consciousness
• Any visual disturbance such as double or blurry vision
• Any hearing problem
• Inability to bring teeth together
• Pain with jaw movement
• Altered sensation on the face
• Face uneven (asymmetrical)
• Open wounds with visible bone

Nasal fracture

• Even if a person has an injury to the nose, it is rare that X-rays will be needed to guide the treatment. A nasal fracture is usually diagnosed by physical exam. The initial care for a nasal injury does not change even if the patient has a fracture.
• If a fracture of the bones high up inside the nose (ethmoid bones) is suspected, the doctor may order a CT scan.

Jaw (mandibular) fracture: If the patient has a possible jaw fracture, the doctor may order an X-ray. Sometimes a special dental X-ray machine may be used to help in the diagnosis. Not all hospitals have this equipment.

Midface (maxillary) fracture

• Because they are most often caused in car accidents, fractures of the midface are often associated with other significant, potentially life-threatening injuries. So diagnosing a facial fracture is often not the most important part of the patient's early treatment.
• After the patient is stabilized, a CT scan of the face is the most useful imaging study to check for a midface fracture.

Cheekbone (zygomatic) fracture

• If the patient is evaluated immediately, the doctor can usually diagnose these by physical exam. This becomes more difficult with time because of swelling.
• Special X-ray views of the zygomatic bone are often helpful. If the patient has a severe fracture involving other bones of the face, the doctor may also order a CT scan to get more information.

Eye socket (orbital) fracture

• X-rays may be helpful in the initial diagnosis.
• If a fracture of the eye socket is shown on your X-ray, the patient will probably have a CT scan to get more information.

Temporomandibular joint dislocation

• If the dislocation is the result of trauma, an X-ray will be done to rule out a fracture of the jaw.
• The patient will not need an X-ray if you have a spontaneous or recurrent dislocation.

Home care is limited until a doctor sees the injured person.

• Use an ice pack on the area to help with pain and swelling.
• Apply direct pressure to bleeding areas.

Nasal fracture

• First, the doctor will control the nosebleed (if the patient has one). If there is a collection of blood inside the nose, called a septal hematoma, the doctor will drain it by cutting a hole in it to let the blood out.
• Because the patient's nose will be very swollen initially, a broken nose is not immediately put back into place (reduced). Even after the swelling improves, reducing a broken nose is necessary only if the patient will have a poor cosmetic result or airflow is obstructed. If it is necessary, a specialist will perform the procedure at a follow-up appointment. By this time, the swelling should have improved, and the bone should be put in place more accurately.
• Fractures of the bones inside the nose (ethmoid fractures) require hospitalization.

Jaw (mandibular) fracture

• A broken bone that is visible through the skin or inside the mouth called an open fracture, requires hospital admission and IV antibiotics.
• Most of the time, if a patient has a closed fracture of the jaw, he or she will be referred to an oral surgeon for treatment.

Midface (maxillary) fracture

• Because of the severity of a midface fracture and its associated injuries, the patient will most likely be hospitalized and may require a tube to be inserted to help them breathe, and the patient will most likely be hospitalized.
• These fractures usually require surgery. This is usually performed by a plastic surgeon or ear, nose, and throat (ENT) specialist.

Cheekbone (zygomatic) fracture: If the patient's zygomatic arch is fractured, he or she may require surgery to repair it if the fracture is pushed in causing a cosmetic defect.

Eye socket (orbital) fracture

• The timing of, and need for eye socket fracture repair is controversial.
• Some specialists feel surgical repair is needed only if the patient has a persistent double vision or the eye recedes into the socket.
• Others use CT scans to help them make the decision. The patient should decide whether to have surgery with the consulting specialist.

Temporomandibular joint dislocation: This is usually realigned in the emergency department. A local anesthetic can be used as well as medication to relax the jaw muscles.

These injuries are often associated with alcohol use and fighting, motor vehicle accidents, and playing sports.

Always wear a seatbelt while driving and use proper protective gear for sports.

Nasal fracture

• The patient will require follow-up care in 5-7 days for re-evaluation after the swelling has subsided.
• If the patient's nose needs to be put back into place, it is usually done at the follow-up visit.
• Prognosis is usually good.

Jaw (mandibular) fracture: Prognosis is usually good.

Midface (maxillary) fracture

• People with midface fractures have a poorer prognosis because of other injuries suffered from the accident that caused their fracture.
• A high incidence of blindness is reported in a particular type of maxillary fracture.

Cheekbone (zygomatic) fracture: As an isolated injury, this usually presents a cosmetic problem only.

Temporomandibular joint dislocation: Be careful not to open the mouth widely after the jaw is put back into place, because of the risk of another dislocation of the joint.