Facial Injuries and Disorders

Facial Injury

One of the most common types of serious injury to the face occurs when bones are broken. Fractures can involve the lower jaw, upper jaw, palate, cheekbones, eye sockets, and combinations of these bones. These injuries can affect sight and the ability to breathe, speak, and swallow. Treatment often requires hospitalization.

Extensive maxillofacial fractures are often accompanied by other medical problems. A thorough physical examination, including neurologic examination, is necessary following a detailed history. Of particular importance are signs of raised intracranial pressure, other cranial nerve dysfunction, or pupillary abnormalities. The head and neck also require careful attention. Numerous neuralgias have been described as causes of facial pain. Neuralgia is defined as paroxysmal pain in the distribution of a particular nerve. The pain is typically maximal at onset and may be described as lancinating, “electric shocks,” or as “jabbing.” There may be a single sharp pain or repetitive pains in succession. The pain can last a fraction of a [Page 650]second or for several seconds. There may be a refractory period after the severe pain during which pain will not occur. Some neuralgic conditions have trigger zones (areas that when stimulated provoke an attack) or other triggers. The oral and maxillofacial surgeon coordinates treatment with other medical specialties to return the patient to his or her normal activities as soon as possible. The principles for treating facial fractures are the same as for a broken arm or leg. The parts of the bone must be lined up (reduced) and held in position long enough to permit them time to heal. This may require six or more weeks depending on the patient's age and the fracture's complexity.

During the healing period when jaws are wired shut, the oral and maxillofacial surgeon prescribes a nutritional liquid or pureed diet, which will help the healing process by keeping the patient in good health. After discharge from the hospital, the doctor gives the patient instructions on continued facial and oral care.

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