Oral and maxillofacial surgeons are trained, skilled, and uniquely qualified to manage and treat facial trauma. They are a vital part of local and trauma city hospitals across the country. They provide emergency room coverage for facial injuries including, but not limited to, facial and oral lacerations, avulsed (knocked out) teeth, fractured jaws, facial bones and orbit, head and neck trauma, treatment of gunshot wounds, dog bites, and motor vehicle crashes that affect the head and face.
Millions of people sustain trauma to the head and face resulting in complex fractures which, if not correctly diagnosed and treated, may cause permanent functional and cosmetic deformities. During the past decade, advances in radiographic procedures, the utilization of craniofacial surgical techniques, and the advent of rigid miniplate fixation have tremendously improved the functional and aesthetic results in facial fracture management.
The accurate diagnosis of facial fractures has been greatly improved by the addition of two- and three-dimensional CT scans which have replaced the plain radiographs. The three-dimensional reconstructions have enhanced preoperative bone analysis and planning by providing a life-like simulation of the fractures.
Injuries to the face, by their very nature, impart a high degree of emotional and physical trauma to patients. The science and art of treating these injuries require special training involving a “hands on experience and an understanding of how the treatment provided will influence the patients long term function and appearance.
The Nature of Maxillofacial Trauma
There are a number of possible causes of facial trauma including motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work related injuries. Types of facial injuries can range from teeth injuries to extensive injuries of the skin and facial bones. Typically, facial injuries are classified as 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). Oral and maxillofacial surgeons are proficient in the diagnosing and treating all types of facial lacerations.
Bone Injuries of the Maxillofacial Region
Fractures of the bones of the face are treated in a manner similar 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, the age, and the general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone allowing for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures. Certain types of jaw fractures are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique, called rigid fixation of a fracture, allows for healing and obviates the necessity of having the jaws wired together. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly.
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 common and may require the expertise of various dental specialists. Oral surgeons usually are 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. Remnants of the ligament that holds the tooth in the jaw are attached to the tooth root 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 the injured teeth cannot be saved or repaired, dental implants are often utilized as replacements for missing teeth.
The proper treatment of facial injuries is now the realm of specialists who are well versed in emergency care, acute treatment, long-term reconstruction, and rehabilitation of the patient.