Facial Trauma
Facial Injuries
There are numerous causes of facial trauma such as gunshot wounds, stabbings, motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. Types of facial injuries can range from simple lacerations and fractures to crushing injuries of the face or total avulsion of facial structures.
Oral and maxillofacial surgeons are trained, skilled, and uniquely qualified to manage and treat facial trauma. Dr. Liao and Dr. Karwowska are specialists in emergency care, acute treatment, and long-term reconstruction and rehabilitation of complex facial injuries. They are both on staff at John Muir Health Walnut Creek Medical Center, a level II trauma center, where they provide emergency room coverage for major facial trauma and operate on patients who need facial reconstruction.
Causes of Facial Trauma
There are numerous causes of facial trauma such as gunshot wounds, stabbings, motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. Types of facial injuries can range from simple lacerations and fractures to crushing injuries of the face or total avulsion of facial structures.
Facial Trauma Treatments
Lacerations
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). Dr. Liao and Dr. Karwowska routinely perform facial laceration repair.
Dentoalveolar (Tooth) Injuries
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral and maxillofacial 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 inside the mouth alongside the cheek. Otherwise, the next best option is storing in milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see an oral surgeon as soon as possible. If the event occurs after hours, proceed to an emergency room. 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, such as endodontists, may be asked to perform root canal therapy. If injured teeth cannot be saved or repaired, dental implants are often utilized as replacements for missing teeth.
Fractures
Fractures of the facial bones 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 to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.
Certain types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique is called the “rigid fixation” of a fracture. The relatively recent development and use of rigid fixation have profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly. When the fractures are located in an area with vital structures nearby, the treatment might be a “closed reduction”, meaning the jaws are wired together.
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.