Facial trauma

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Facial trauma
1865 illustration of a private injured in the American Civil War by a shell two years previously
SpecialtyOral and maxillofacial surgery Edit this on Wikidata

Facial trauma, also called maxillofacial trauma, is any

facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries
. Symptoms are specific to the type of injury; for example, fractures may involve pain, swelling, loss of function, or changes in the shape of facial structures.

Facial injuries have the potential to cause disfigurement and loss of function; for example, blindness or difficulty moving the jaw can result. Although it is seldom life-threatening, facial trauma can also be deadly, because it can cause severe bleeding or interference with the

suturing of open wounds, administration of ice, antibiotics and pain killers, moving bones back into place, and surgery. When fractures are suspected, radiography is used for diagnosis. Treatment may also be necessary for other injuries such as traumatic brain injury
, which commonly accompany severe facial trauma.

In developed countries, the leading cause of facial trauma used to be

sports injuries
.

Signs and symptoms

Bruising, a common symptom in facial trauma

Le Fort fractures, the midface may move relative to the rest of the face or skull.[5]

Cause

Injury mechanisms such as falls, assaults,

gunshots and blasts
. Animal attacks and work-related injuries such as industrial accidents are other causes.
lacerations (cuts) to the face when they deploy.[10]

Diagnosis

Left orbital floor fracture

CT scanning is better for detecting fractures and examining soft tissues, and is often needed to determine whether surgery is necessary, but it is more expensive and difficult to obtain.[4] CT scanning is usually considered to be more definitive and better at detecting facial injuries than X-ray.[3] CT scanning is especially likely to be used in people with multiple injuries who need CT scans to assess for other injuries anyway.[12]

Classification

Le Fort I fractures
Le Fort II fractures
Le Fort III fractures

Soft tissue injuries include

bruises, burns and cold injuries.[3]

The facial bones

Commonly injured facial bones include the

mandible (the lower jaw). The mandible may be fractured at its symphysis, body, angle, ramus, and condyle.[4] The zygoma (cheekbone) and the frontal bone (forehead) are other sites for fractures.[13]
Fractures may also occur in the bones of the palate and those that come together to form the orbit of the eye.

At the beginning of the 20th century,

lamina papyracea, and the orbital floor, and often involve the ethmoid bone,[15] are the most serious.[18] Le Fort fractures, which account for 10–20% of facial fractures, are often associated with other serious injuries.[15] Le Fort made his classifications based on work with cadaver skulls, and the classification system has been criticized as imprecise and simplistic since most midface fractures involve a combination of Le Fort fractures.[15] Although most facial fractures do not follow the patterns described by Le Fort precisely, the system is still used to categorize injuries.[5]

Prevention

Measures to reduce facial trauma include laws enforcing seat belt use and public education to increase awareness about the importance of seat belts[8] and motorcycle helmets.[9] Efforts to reduce drunk driving are other preventative measures; changes to laws and their enforcement have been proposed, as well as changes to societal attitudes toward the activity.[8] Information obtained from biomechanics studies can be used to design automobiles with a view toward preventing facial injuries.[7] While seat belts reduce the number and severity of facial injuries that occur in crashes,[8] airbags alone are not very effective at preventing the injuries.[3] In sports, safety devices including helmets have been found to reduce the risk of severe facial injury.[19] Additional attachments such as face guards may be added to sports helmets to prevent orofacial injury (injury to the mouth or face);[19] mouth guards also used. In addition to factors listed above, correction of dental features that are associated with receiving more dental trauma also helps, such as increased overjet, Class II malocclusions, or correction of detofacal deformities with small mandible [20][21]

Treatment

Before
After
Woman with a prosthesis for facial trauma, 1900-1950

An immediate need in treatment is to ensure that the airway is open and not threatened (for example by tissues or foreign objects), because

tracheostomy can secure an airway when other methods fail, they are used only as a last resort because of potential complications and the difficulty of the procedures.[4]

Sutures may be used to close wounds.

A

antibiotic treatment.[2]

Treatment aims to repair the face's natural bony architecture and to leave as little apparent trace of the injury as possible.[1] Fractures may be repaired with metal plates and screws commonly made from Titanium.[1] Resorbable materials are also available; these are biologically degraded and removed over time but there is no evidence supporting their use over conventional Titanium plates.[24] Fractures may also be wired into place. Bone grafting is another option to repair the bone's architecture, to fill out missing sections, and to provide structural support.[1] Medical literature suggests that early repair of facial injuries, within hours or days, results in better outcomes for function and appearance.[12]

Surgical specialists who commonly treat specific aspects of facial trauma are oral and maxillofacial surgeons, otolaryngologists, and plastic surgeons.[4] These surgeons are trained in the comprehensive management of trauma to the lower, middle and upper face and have to take written and oral board examinations covering the management of facial injuries.

Prognosis and complications

Diagram of lateral view of face showing the imaginary line between the tragus of the ear and the middle of the upper lip. The middle third of this line is the approximate location of the course of the parotid duct. If facial lacerations cross this line, there is a risk that the parotid duct is damaged.

By itself, facial trauma rarely presents a threat to life; however it is often associated with dangerous injuries, and life-threatening complications such as blockage of the airway may occur.[4] The airway can be blocked due to bleeding, swelling of surrounding tissues, or damage to structures.[25] Burns to the face can cause swelling of tissues and thereby lead to airway blockage.[25] Broken bones such as combinations of nasal, maxillary, and mandibular fractures can interfere with the airway.[1] Blood from the face or mouth, if swallowed, can cause vomiting, which can itself present a threat to the airway because it has the potential to be aspirated.[26] Since airway problems can occur late after the initial injury, it is necessary for healthcare providers to monitor the airway regularly.[26]

Even when facial injuries are not life-threatening, they have the potential to cause disfigurement and disability, with long-term physical and emotional results.[7] Facial injuries can cause problems with eye, nose, or jaw function[1] and can threaten eyesight.[12] As early as 400 BC,

retrobulbar hemorrhage, can threaten eyesight; however, blindness following facial trauma is not common.[27]

Incising wounds of the face may involve the parotid duct. This is more likely if the wound crosses a line drawn between the tragus of the ear to the upper lip. The approximate location of the course of the duct is the middle third of this line.[28]

Nerves and muscles may be trapped by broken bones; in these cases the bones need to be put back into their proper places quickly.

tear ducts and nerves of the face may be damaged.[3] Fractures of the frontal bone can interfere with the drainage of the frontal sinus and can cause sinusitis.[30]

Infection is another potential complication, for example when debris is ground into an abrasion and remains there.[4] Injuries resulting from bites carry a high infection risk.[3]

Epidemiology

As many as 50–70% of people who survive traffic accidents have facial trauma.

mandible (the jawbone) are not decreased by these protective measures.[10] The risk of maxillofacial trauma is decreased by a factor of two with use of motorcycle helmets.[10] A decline in facial bone fractures due to vehicle accidents is thought to be due to seat belt and drunk driving laws, strictly enforced speed limits and use of airbags.[8] In vehicle accidents, drivers and front seat passengers are at highest risk for facial trauma.[10]

Facial fractures are distributed in a fairly

cancellous bone in children's faces, poorly developed sinuses make the bones stronger, and fat pads provide protection for the facial bones.[4]

spinal injury.[26]

References

  1. ^ a b c d e f g h i j Seyfer AE, Hansen JE (2003). pp. 423–24.
  2. ^
    ISBN 0-07-135294-5
    .
  3. ^
    ISBN 0-7817-5561-1. Archived
    from the original on 2017-02-02. Retrieved 2008-10-19.
  4. ^ a b c d e f g h i j k l Neuman MI, Eriksson E (2006). pp. 1475–77.
  5. ^ a b Kellman RM. Commentary on Seyfer AE, Hansen JE (2003). p. 442.
  6. S2CID 231900892
    .
  7. ^
    ISBN 0-387-98820-3. Archived
    from the original on 2017-11-06. Retrieved 2008-10-08.
  8. ^
    PMID 11382418
    .
  9. ^
    PMID 16270942
    .
  10. ^ a b c d e Hunt JP, Weintraub SL, Wang YZ, Buechter KJ (2003). "Kinematics of trauma". In Moore EE, Feliciano DV, Mattox KL (eds.). Trauma. Fifth Edition. McGraw-Hill Professional. p. 149.
    ISBN 0-07-137069-2
    .
  11. ^ a b Jeroukhimov I, Cockburn M, Cohn S (2004). pp.10–11.
  12. ^
    PMID 18178381
    .
  13. ^ a b Neuman MI, Eriksson E (2006). pp. 1480–81.
  14. ^ "Le Fort I fracture" at Dorland's Medical Dictionary.
  15. ^ a b c d e Shah AR, Valvassori GE, Roure RM (2006). "Le Fort Fractures". EMedicine. Archived from the original on 2008-10-20.
  16. ^ "Le Fort II fracture" at Dorland's Medical Dictionary.
  17. ^ "Le Fort III fracture" at Dorland's Medical Dictionary.
  18. ^ "Le Fort fracture" at Dorland's Medical Dictionary.
  19. ^
    PMID 15911597. Archived
    from the original on 2007-10-09.
  20. PMID 21880516
    .
  21. PMID 20831636
    .
  22. ^ a b Jeroukhimov I, Cockburn M, Cohn S (2004). pp.2–3.
  23. PMID 18262768
    .
  24. doi:10.1002/14651858.cd007158.pub3. If this is an intentional citation to a retracted paper, please replace {{Retracted}} with {{Retracted
    |intentional=yes}}.)
  25. ^ a b Parks SN (2003). "Initial assessment". In Moore EE, Feliciano DV, Mattox KL (eds.). Trauma. Fifth Edition. McGraw-Hill Professional. p. 162.
    ISBN 0-07-137069-2
    .
  26. ^
    PMID 18207702
    .
  27. PMID 16023907
    .
  28. PMID 20684461. Archived
    (PDF) from the original on 2016-03-04.
  29. ^ Seyfer AE, Hansen JE (2003). p. 434.
  30. ^ Seyfer AE, Hansen JE (2003). p. 437.
  31. ^ Neuman MI, Eriksson E (2006). p. 1475. "The age distribution of facial fractures follows a relatively normal curve, with a peak incidence between 20 and 40 years of age."
  32. ^ Jeroukhimov I, Cockburn M, Cohn S (2004). p. 11. "The incidence of brain injury in patients with maxillofacial trauma varies from 15 to 48%. The risk of serious brain injury is particularly high with upper facial injury."

Cited texts

Further reading

External links

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