Plastic Procedures > Reconstructive Procedures > Traumatology
What are the Facial bones and Facial Fractures?
Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries.
Commonly injured facial bones include the Nasal bone (the nose), the Maxilla (the bone that forms the upper jaw), and the Mandible (the lower jaw). The mandible may be fractured at its symphysis, body, angle, ramus, and condoyle. The Zygoma (cheekbone) and the Frontal bone (forehead) are other sites for fractures. Fractures may also occur in the bones of the Palate and those that come together to form the Orbit of the eye.
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 airway; thus a primary concern in treatment is ensuring that the airway is open and not threatened so that the patient can breathe.
Depending on the type of facial injury, treatment may include bandaging and 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 facial trauma.
The leading cause of facial trauma used to be motor vehicle accidents, but this mechanism has been replaced by interpersonal violence; however auto accidents still predominate as the cause in developing countries and are still a major cause elsewhere.
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Classification of Facial Fractures:
At the beginning of the 20th century, René Le Fort mapped typical locations for facial fractures; these are now known as Le Fort I, II, and III fractures:
- Le Fort I fractures, also called Guérin or horizontal maxillary fractures, involve the maxilla, separating it from the palate.
- Le Fort II fractures, also called pyramidal fractures of the maxilla, cross the nasal bones and the orbital rim.
- Le Fort III fractures, also called craniofacial disjunction and transverse facial fractures, cross the front of the maxilla and involve the lacrimal bone, the lamina papyracea, and the orbital floor, and often involve the ethmoid bone. are the most serious.
Le Fort fractures, which account for 10–20% of facial fractures, are often associated with other serious injuries. Although most facial fractures do not follow the patterns described by Le Fort precisely, the system is still used to categorize injuries.
Causes of Facial Trauma:
- Falls, assaults, sports injuries, and vehicle crashes are common causes of facial trauma in children as well as adults.
- Blunt assaults, blows from fists or objects, are a common cause of facial injury.
- Facial trauma can also result from wartime injuries such as gunshots and blasts.
- Animal attacks and work-related injuries such as industrial accidents are other causes.
- Vehicular trauma is one of the leading causes of facial injuries.
Manifestations and Complications of Facial Trauma:
- Like other fractures, there may be pain, bruising, and swelling of the surrounding tissues. Asymmetry can suggest facial fractures or damage to nerves.
- With fractures of the nose, base of the skull or maxilla, there may be profuse nasal bleeding.
- Deformity in the face, for example a sunken cheekbone or teeth which do not align properly, suggests the presence of fractures. Nasal fractures may be associated with deformity of the nose.
- With Mandibular fractures, there may be pain and difficulty in mouth opening and may have numbness in the lip and chin. Malocclusion (Angle Classification)
- With Le Fort fractures, the midface may move relative to the rest of the face or skull.
- Nerves and muscles may be trapped by broken bones; in these cases the bones need to be put back into their proper places quickly. For example, fractures of the orbital floor or medial orbital wall of the eye can entrap the medial rectus or inferior rectus muscles causing double vision (Diplopia).
- In facial wounds, tear ducts and nerves of the face may be damaged.
- Fractures of the frontal bone can interfere with the drainage of the frontal sinus and can cause sinusitis.
- Infection is another potential complication, for example when debris is ground into an abrasion and remains there.
- Coexisting injuries can affect treatment of facial trauma; for example they may be emergent and need to be treated before facial injuries. People with trauma above the level of the collar bones are considered to be at high risk for cervical spine injuries (spinal injuries in the neck) and special precautions must be taken to avoid movement of the spine, which could worsen a spinal injury.
Clinical Work up to Diagnose the Facial Trauma:
- Radiography (X-rays): is used to rule out facial fractures. Panoramic view is used for evaluation of Mandibular fractures.
- Angiography (X-rays taken of the inside of blood vessels) can be used to locate the source of bleeding.
- CT scanning: is better for detecting fractures and examining soft tissues, and is often needed to determine whether surgery is necessary.
How Are the Facial Fractures could be treated?
- An immediate need in treatment is to ensure that the airway is open and not threatened (for example by tissues or foreign objects).
- Sutures may be used to close wounds.
- Nasal packing can be used to control nose bleeds and hematomas that may form on the septum between the nostrils.
- Treatment aims to repair the face's natural bony architecture and to leave as little apparent trace of the injury as possible. Fractures may be repaired with metal plates and screws. They 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.
How Much Do Management of Facial Fractures Typically Cost?
Often the price says nothing about the quality of the work. Most multicenter clinics charge much more than private doctors — their advertising budget is more and the owner of the clinic has to take his 20% or 30% off the top. In my opinion, you are less likely to get a quality procedures at these multi-center locations.
Although price is a factor when deciding on surgery, the most important factor is that you feel you are getting a good quality, natural-looking result from the procedure.
Management of Facial Fractures' costs are variable according to the deformity and the used technique. Usually the cost is ranging from 2000 to 2500 U.S. dollars. Most medical insurance providers cover these procedures.
Summary of Facial Fractures Repair Procedures:
The time of the procedure: from two to four hours.
Type of anesthesia:General.
Location: hospital with one postoperative day hospital stay.
Expected Side effects: Temporary swelling and pain.
Recovery time: return to work within 3 weeks.
Cost: according to procedure ranging from 2000 to 2500 U.S. dollars, or 11,500 to 16,000 Egyptian pounds.
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