Facial Trauma

Oral Surgery Norwood, MA | Mansfield, MA

Injuries to the face impart a high degree of emotional as well as physical trauma to patients. Management of facial trauma requires professionals who are experienced in emergency care, treatment of acute injuries, and long-term reconstruction and rehabilitation. Due to their rigorous hospital-based surgical training and extensive knowledge regarding facial anatomy, teeth, dental occlusion, and jaw function, Oral and Maxillofacial Surgeons are uniquely qualified to manage facial trauma.

As a Board Certified Oral and Maxillofacial Surgeon, Dr. Turesky has extensive experience in all aspects of oral and maxillofacial trauma including:

• Facial lacerations
• Intra oral lacerations
• Avulsed (knocked out) and subluxated (displaced) teeth
• Fractured facial bones
• Fractured jaws (upper and lower jaw)

The Nature of Maxillofacial Trauma

The most common causes of facial trauma include motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. The degree of facial trauma can range from small lacerations and isolated injuries of teeth to massive injuries of the skin and bones of the face and supporting structure of the teeth. Facial injuries are classified as soft tissue injuries (skin and gums), bone injuries (fractures), and injuries to special regions (such as the eyes, facial nerves, or the salivary glands).

Soft Tissue Injuries of the Maxillofacial Region

When soft tissue injuries such as lacerations occur on the face, they are repaired by suturing. Treatment of combined intra-oral/extra-oral lacerations requires special management. In addition to the obvious concern for providing a repair that yields the best cosmetic result possible, special consideration must be given to structures such as facial nerves, salivary glands, and salivary ducts (or outflow channels) in order to reestablish normal function.

Bone Injuries of the Maxillofacial Region

Fractured bones need to be reduced (repositioned) and immobilized (stabilized) in order to heal properly. When an arm or a leg is fractured, a cast is applied to stabilize the bone and promote proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.

The most common treatment for maxillary and/or mandibular fractures is a closed reduction (wiring the jaws together). Special consideration must be given to the dentition (teeth and their supporting structures) in order to restore a satisfactory occlusion (bite). The teeth and fractured bones must be properly aligned to achieve a functional, comfortable and esthetic result. This is accomplished during the wiring process. Most adult fractures are wired together for six weeks, however, condyle (jaw joint) fractures are an exception. Condyle fractures require early mobilization and gentle exercise to help reestablish the full range of motion. Condyle fractures are usually immobilized for 10-14 days before starting exercises.

Certain types of fractures of the jaw are managed by the surgical placement of small plates and screws at the fractured site. In select cases, the use of plates can eliminate the necessity of wiring the jaws together. This surgical technique for the treatment of facial fractures is called open reduction with rigid fixation.

In cases of complex multiple facial fractures, every attempt is made to restore the patient’s appearance, comfort and function while minimizing surgical intervention as much as possible. Surgical access to injured facial bones is accomplished through the fewest possible number of incisions. Whenever possible, existing lacerations are used to gain access to the fracture sites. Incisions are designed to be small and positioned to minimize or hide surgical scars.

Subluxated (Displaced) and Avulsed (Knocked Out) Teeth

Subluxated and avulsed teeth are very common injuries, especially among children and teenagers. These injuries may require the expertise of various dental specialists.

Oral and maxillofacial surgeons treat subluxated and avulsed teeth by repositioning or reinserting the teeth into their proper location and securing them with splinting (stabilization by wiring or bonding teeth together). The splints are usually removed six weeks after placement.

If a permanent tooth is avulsed, it should be reinserted back into its socket as quickly as possible; the tooth socket is the best environment for an avulsed tooth. If the tooth is soiled a quick gentle rinse with clean warm water prior to reinsertion is advised. Handling of the root should be avoided if possible. Never attempt to wipe off material from the tooth root, since this can damage the periodontal ligament. The periodontal ligament attaches the tooth to the jaw bone; its survival is vital for successful tooth re-implantation. If it is impossible to immediately reinsert the tooth into the socket, it should be stored in warm salt water (1/2 teaspoon of salt mixed in one glass of water).

The sooner the tooth is re-inserted into its socket the better its chances for survival. There is a 50% chance of tooth survival if it is reinserted into its socket within 30 minutes. There is virtually no chance of tooth survival if it remains out of its socket for more than one hour, regardless of how it is stored. Since time is of the essence, the patient should see a dentist or oral surgeon as soon as possible after injury.

All re-implanted avulsed teeth and most subluxated teeth require root canal therapy. Sometimes root canal treatment can be started two weeks after splinting. Frequently, root canal therapy must wait until after the splint has been removed. Chipped or fractured teeth can be repaired by the general dentist with bonding or a crown after the splint has been removed.

In the event that injured teeth cannot be saved or repaired, dental implants are usually the best way to replace missing teeth.

Subluxated deciduous teeth (baby teeth) are not salvageable and should be extracted. Attempting to save a subluxated deciduous tooth with splinting can result in ankylosis (bonding the tooth root to the bone). An ankylosed deciduous tooth will interfere with the eruption of the permanent tooth. Deciduous teeth that have been avulsed also have no chance for survival and are not reinserted into their sockets.