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BChD, Dip Odont. (Mondchir.) MBChB, MChD (Chir. Max.-Fac.-Med.) Univ. of Pretoria Co Reg: 2012/043819/21 Practice.no: 062 000 012 3323

FACIAL FRACTURES AND INJURIES Maxillofacial injuries also referred to as facial trauma, involve any injury to the mouth, face and jaw. There are a number of possible causes of facial trauma such as motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to specific regions (such as the eyes, facial nerves or the salivary glands). Injuries can vary from dislodged (bumped out) teeth to complex combination of fractures of the bones of the face i.e. 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 hospitalisation and cannot be fixed immediately, as the swelling needs to subdue, and more serious injuries need to be treated first.

Maxillofacial and Oral Surgeons are trained, skilled and uniquely qualified to manage and treat facial trauma. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires an understanding of how the treatment provided will influence the patient’s long term function and appearance.

EXAMPLES OF FACIAL FRACTURES

Zygomatic arch fracture Mandibular fractures Mid-facial fractures

BONE INJURIES: The fracture is treated under general anaesthetic by placing plates and screws in place to hold the fractured bone segments together. This is done in a manner to ensure that the fewest number of scars are left on the face. This technique is called "rigid fixation" of a fracture. 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. 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. Once it is completely healed (this takes about two months) the plates and screws may be removed. Additional operations may be required after 6-12 months to ensure a pre-treatment facial structure.

SOFT TISSUE INJURIES: 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).

After the fractures have been repaired, a healing time of between 4-6 weeks (often longer in more extensive cases) should be allowed. During this time the patient will need to follow a diet that is adapted to his/her own special circumstances and can differ from a strict fluid diet to a diet of semi-solid foods. Special attention to oral hygiene is essential. Physiotherapy is also valuable in the rehabilitation, especially in injuries of the jaw-joint or extensive skin and muscle injuries.