The most common facial bones injured are the lower jaw (mandible), upped jaw (maxilla), the cheekbone (zygoma), the nasal bones and orbital bones (which surround the eye socket), and least common of all, the frontal bone (which makes up the bony part of the forehead). Facial bone injuries are common in falls, assaults and sporting injuries.
They can be associated with other major injuries, called polytrauma, and as a result, maxillofacial surgeons often manage these injuries as part of the trauma team including neurosurgeons, orthopaedic surgeons, and dentists. Facial fractures are also often associated with nasty cuts and grazes, so plastic surgery is important too.
Mandible fractures are usually very painful, you quite often feel that your teeth are not meeting properly, often have bruising over the face and bleeding in the mouth, and diagnosis requires X-rays or even better, a cone-beam CT scan. Surgery usually requires fixation of the fractures with small plates and screws. One of the most frequently missed mandible fractures, is when it involves the jaw joint (TMJ) this is particularly important in a growing child but is also important in adults and can lead to long term arthritis.
Maxillary fractures are rare in isolation, but they can happen with a direct blow to the upper jaw and cause the upper jaw to fracture from the base of the skull. They’re classified according to Le Fort, who was a French army surgeon. Maxillary fractures are diagnosed with cone-beam CT scans and if necessary fixed with metal plates.
Cheekbone fractures are very common and are the result of a blow to the side of the face or to the cheek prominence from the front. They cause swelling, pain, bruising and numbness of the face, and usually require surgery to reposition the bone and fix it with small metal plates.
Nasal fractures are very common and can be associated with cartilage damage as well. Treatment is usually in 2 stages, with an initial manipulation, where you straighten the bone and the septum within a week or two of the injury. If the outcome is not satisfactory, it can be treated with a septorhinoplasty by a plastic surgeon or rhinologist at a later stage.
Orbital fractures can be very complex and require liaison between the maxillofacial and ophthalmic surgeons. Small fractures usually don’t require treatment, ‘blow-out’ fractures on the other hand can cause double vision and a sunken eye appearance, which is not usually acceptable. If you suspect an orbital floor fracture, it is very important you see an ophthalmic surgeon immediately, as there is a chance you have an injury to the eyeball itself, which is much more urgent, and if not diagnosed and treated, could be serious. If the orbital fracture needs to be repaired, this is usually done using computer aided design and manufacture of a custom implant at approximately three months post injury.
Frontal bone fractures are very rare, because it requires a lot of energy to fracture the frontal bone. It can be associated with brain or neck injuries, and always requires a CT scan. Patients are recommended to see a neurosurgeon due to the possibility of brain injuries, especially post-concussion.