Facial Trauma

Maxillofacial Trauma

In India, the major cause of facial injuries is associated with road traffic accidents, inter-personal violence, sports injury. The severity depends on the velocity of the trauma and protection at the time of injury. Wearing helmets while riding a 2-wheeler and seat belt when driving a 4-wheeler helps reduce the severity of trauma to the face. The type of injury varies from simple lacerations to multiple facial bone fractures. These can also be associated with injuries to other areas of the body. The treatment will depend on the type of injury sustained.

Soft Tissue Injury

It can vary from small cut wounds to big abrasive wounds and degloving wounds. The primary aim is to clean the wound thoroughly and help heal with minimal scarring. The surgical procedure will vary according to the type of wound and amount of soft tissue loss. Simple cut wounds can be sutured whereas bigger wounds will require sion graft or flap surgery to aid in healing.

Does a small cut would which is less than a centimeter needs to be stitched?
A deep small cut needs to be sutured as it will help to minimize the scar. 

Do I need to stay in the hospital?
If the procedure is done only under local anesthaesia then the patient can go home after the operation Bigger wounds which are bleeding prafusely or multiple wounds that need to be deaned and stitched may require general anaesthesia. In some cases where there is tissue loss, a skin graft or flap surgery may be done to dose the wound. In such instances the patient will need to be admitted in the hospital.

How to take care of the wound?
If there is no dressing, the patient can start to wash his face regularly with facewash and then apply antiseptic ointment. This will help to keep the wound dean and prevent any infection. The sutures then are removed after a week, in case of skin grafting the patient will have a dressing for 2 weeks. Patient can start to wash the face after the dressing is removerd.

Treatment of scars
The patient initiates scar massage about a week after the stitches are removed. The process of massaging the scar is taught to the patient who will do it for about a year. Sometimes a little extra help may be required to settle scars. This involves the use of pressure garments and slicone gel sheet application.

Will I need a second surgery?
This will depend on the scar healing, Scar massage needs to be done for a minimum of 6 months to soften the scar and prior to deciding on the need for a correction surgery. There are chances for the scar to become big or distort the farial structures, we can correct them with flaps or fat grafting .

Will the lost hair lost on the mustache and eyebrow regrow?
Hair does regrow on the procedure called Hair Transplant line. However once healing neeurs hair growth in the adjacent area may mask the scar, if required a maybe done to help cover the scar.

Dentoalveolar Injury

Normal anatomy of a tooth and its supporting structures
The part of the tooth that can be seen in the mouth is called the crown and the part that is within the bone (alveolar socket) is called the root The tooth has blood vessels and nerves within the purp chamber and the canals making it a viable structure

The injuries to the tooth can be
Dentoalveolar fractures Fractures of parts of the tooth and its underlying bone Concussions-blunt injury to the tooth Luovations When the sooth has lost its support and is moving within the socket. Intrusion and exte whole tooth is lost and completely out of the socket

Can an avulsed tooth (tooth that has come out of the bone and is without a fracture) be replanted back in the socket?
Only the permanent tooth can be replanted back in the socket and not the primary (baby) tooth. The criteria for good outcome following replantation of a completely avulsed tooth arer The tooth should be roper manner (as described below) to the doctor within an hour after it has fallen out so that he can successfully place the tooth back in its socket. There should be no associatest root fractures The supporting periodomalgamem supporting garment present on the surface of the root of the tooth) should be viable at the time of replantation

How to get at red tooth to the hospital?
The tooth needs in running water to rer tooth back in the bony socket from where it was lost. You can also place it in a container filled with milk or tender c coconut water. scrub the ot as it will remove off the penodontal ligan attachment of the tooth and if found good, ve dirt. Make sure of the The tooth needs to be kept moist and the best way to do that is to genity put hospital the will asses Once con stabil taking support from the adjacent good teeth by means of splinting (using wire, clips or cement).

How long will the splinting be in place?
The arch bar and wires will be retained for a perind of li to E weeks. Once the teeth are firm the arch bar and wires will be removed in the outpatient department. This will be followed up with a dental Xray and RCT (root canal treatment) for the involved teeth.

What can I eat during the time that my teeth are splinted?
It will best be to have a liquid or semisolid diet to avoid puting any pressure on the teeth sil they heal. No chewing allowed for weeks!

Upper and Lower Jaw Fractures

When can I suspect that my jaw is fractured?
When the upper jaw (maxilla) or the lower jaw (mandible) is fractured you will notice that your teeth do not contact well, face appears swollen or deformed and you have difficulty opening the mouth. You will also experience pain when chewing on food. There may be bleeding from your mouth and hematomas in the cheek, floor of the mouth or in the palate. Some teeth may be lost or mobile.

Do I need surgery?
Surgery needs to be done for most of the fractures of the jaw. It will be done under general anesthesia and the fractures will be fixed using titanium plates and screws (ORIF-Open reduction and internal fixation). In some cases, the fractures are not very much displaced and in this situation they can either be managed without any surgery or by means of intermaxillary fixation (wiring the teeth together).

What is intermaxillary fixation
Intermaxillary fixation is basically wiring up the upper and lower jaws together such that you cannot open your mouth. It will be retained for a minimum of 2 to 6 weeks depending on the location of the fracture and how much it affects the way your teeth occlude. During this period, you need to be on a liquid diet. You can keep your oral cavity clean by regular brushing and gargling with a germicidal mouth rinse. Once the wired jaws are released, you need to do rigorous mouth opening exercises to improve the mouth opening. You can also start having solid foods and maintain better oral hygiene.

What do I need to do when my fractures are fixed?
If the fractures are fixed you need to be on a semisolid diet followed by soft diet for a period of 6 weeks after which you can resume a normal diet based on how the healing has taken place. Sometimes even if the fracture is fixed the jaws can be wired. This is done especially when there is more than one fracture or if it is comminuted (broken into many bits.) In that case you need to follow the instructions as for intermaxillary fixation. It is important that you maintain good oral hygiene by regular brushing and rinsing as there will be stitches inside your mouth which can get infected.

Do I need to remove the implants after recovery?
Usually, titanium plates need not be removed. There is more than 90% success rate. If there is infection following surgery, plates and screws may be removed only after a minimum of a year’s time. Till then we will be treating him with medications.

What are the expected complications following surgery?
Infection at surgical site, nonunion of the bone, wrong union (malunion) of the bone, numbness over lip or cheek depending on the fracture. All these are treatable. Numbness usually settles over a period while infection is treated with medicines. In case of nonunion In case of nonunion or wrong union, further surgery may be needed to correct the problem.

Cheek Bone Fractures

Cheek bone fracture also referred to as zygomatic complex fracture. This fracture presents with redness of the eye and bruising of the eyelids, flattening of the cheek on the involved side and numbness of the cheek, upper lip and teeth of that side. Patient can also experience pain and restriction while opening the mouth and chewing food. Sometimes the vison in the same side eye can also be affected. Immediately after the injury there can can also bleeding from the nose and mouth. This fracture can also occur along with fracture of the upper jaw in which case the patient will have disturbance in his bite.

What is the treatment?
Grossly displaced fractures need treatment as there will be severe restriction in opening the mouth and flattening of the cheek. The procedure is done under general anesthesia. Most of the accesses to this fracture will not cause any scarring on the face. Depending on the need, the fracture will be fixed with plates and Screws.

What are the precautions that I need to take following surgery?
The following set of instructions will be given to the patient prior to discharge following surgery for correction of cheek bone fracture While sleeping the patient needs to keep the head end elevated and not apply any pressure on the surgical side. This needs to be followed for a period of 6 weeks till the bone heals. Patients are instructed to take soft diet and follow good oral hygiene measures even if they have stitches place inside the mouth. Normal diet can be resumed 6 weeks later. Patient can also take a bath everyday even when there are stitches in the scalp. Keeping the surgical site clean is of utmost importance to avoid infection. Mouth opening exercises are taught to the patient on their first follow up. Doing the exercises regularly and as instructed will help improve the mouth opening to the preinjury mouth opening.

Will the sensations over the cheek, nose, lips and teeth return?
The numbness is caused because the sensory nerve is crushed when the bo between three months to 2 years.