Facial Fracture

Facial Fracture Overview

A fracture is a broken bone. Facial fracture refers to any injury that results in a broken bone or bones of the face.

Facial Fracture Causes

Many situations can cause facial fractures. Motor vehicle crashes, sporting injuries, falls, and assault account for the majority, although injuries from gunshot wounds and stabbings occur as well.

Always be concerned about other injuries with facial fractures. In particular, other parts of the body may be injured, for example, if you have facial injuries in a motor vehicle accident.

Facial Fracture Symptoms

Although certain symptoms are specific for the bone fractured, some symptoms are common to any fractured bone. But remember that these symptoms may also indicate a soft tissue injury (without a broken bone).

  • Pain
  • Swelling
  • Bruising

Symptoms of a broken nose include:

  • Swelling
  • Tenderness
  • Deformity
  • Nosebleed (if present, is usually minor)

Significant trauma to the bridge of the nose may result in a fracture of the bones inside your nose (ethmoid bones). These bones, if fractured, may cause the brain to connect with the outside environment. Possible symptoms include persistent nosebleed or a clear nasal discharge.

Symptoms of a broken jaw include:

  • Jaw pain
  • Tenderness
  • Inability to bring the teeth together properly (malocclusion)
  • Bruising under the tongue (almost always indicates a jaw fracture)

Symptoms of a midface (maxillary) fracture include:

  • Inability to bring the teeth together properly
  • Visual problems
  • Clear nasal discharge
  • Bruising around the eyes
  • Midface may be able to be moved.

These fractures are not usually subtle and are often the result of high-speed car accidents. As a result, there might be severe injury to areas other than the face. Many people with this type of fracture will have difficulty breathing and require a tube to be placed down their throat to help them breathe.

Symptoms of a cheekbone (zygomatic) fracture include:

  • Flatness of the cheek
  • Altered sensation underneath the eye on the affected side
  • Visual complaints
  • Pain with jaw movement
  • Blood in the side of the eye on the affected side

Symptoms of an eye socket (orbital) fracture include:

  • Sunken eye (enophthalmos)
  • Altered sensation beneath the affected eye
  • Double vision, particularly with upward gaze

This fracture involves the bones of the eye socket. Injury usually occurs when a blunt object such as a fist or a ball hits the eye.

Symptoms of a temporomandibular joint ( TMJ ) dislocation include:

  • Jaw deviation
  • Inability to close the mouth

Dislocation of the TMJ (the joint where your jaw meets with the temporal bone, right in front of your ear) can occur with blunt trauma, seizures, or excessive mouth opening.

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When to Seek Medical Care

A doctor should check all people with facial trauma. In the event of massive trauma, call 911.

For any other significant facial injury, you can either go to a hospital emergency department or see your own doctor.

Any of the the following symptoms need to be evaluated by a doctor:

  • Clear nasal discharge
  • Nosebleed
  • Loss of consciousness
  • Any visual disturbance such as double or blurry vision
  • Any hearing problem
  • Inability to bring teeth together
  • Pain with jaw movement
  • Altered sensation on the face
  • Face uneven (asymmetrical)
  • Open wounds with visible bone

Exams and Tests

The exam and the types of tests that are used depend on the type of injury you have.

Nasal fracture

Even if you have an injury to your nose, it is rare that X-rays will be needed to guide the treatment. A nasal fracture is usually diagnosed by physical exam. The initial care for a nasal injury does not change even if you have a fracture.

If a fracture of the bones high up inside the nose (ethmoid bones) is suspected, the doctor may order a CT scan.

Jaw (mandibular) fracture

If you have a possible jaw fracture, your doctor may order an X-ray. Sometimes a special dental X-ray machine may be used to help in the diagnosis. Not all hospitals have this equipment.

Midface (maxillary) fracture

Because they are most often caused in car accidents, fractures of your midface are often associated with other significant, potentially life-threatening injuries. So diagnosing a facial fracture is often not the most important part of your early treatment.

After you are stabilized, a CT scan of the face is the most useful imaging test for checking for a midface fracture.

Cheekbone (zygomatic) fracture

If you are evaluated right away, the doctor can usually diagnose a cheekbone fracture by physical exam. This becomes more difficult with time because of swelling.

Special X-ray views of the zygomatic bone are often helpful. If you have a severe fracture involving other bones of the face, your doctor may also order a CT scan to get more information.

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Eye socket (orbital) fracture

X-rays may be helpful in the initial diagnosis of a fractured eye socket.

If a fracture of your eye socket is shown on your x-ray, you will probably have a CT scan so the doctor can get more information.

Temporomandibular joint dislocation

If the dislocation is the result of trauma, an X-ray will be done to rule out a fracture of the jaw. You will not need an X-ray if you have a spontaneous or recurrent dislocation.

Facial Fracture Treatment - Self-Care at Home

Home care is limited until a doctor sees you. While waiting to see the doctor, use an ice pack on the area to help with pain and swelling, and apply direct pressure to bleeding areas.

Medical Treatment

Treatment depends on the type of injury you have.

Nasal fracture

First, the doctor will control your nosebleed (if you have one). If there is a collection of blood inside your nose, called a septal hematoma, the doctor will drain it by cutting a hole in it to let the blood out.

Because your nose will be very swollen at first, a broken nose is not immediately put back into place. Even after the swelling goes down, putting a broken nose back in place is necessary only if you will have a poor cosmetic result or your airflow is obstructed. If it is necessary, a specialist will do it at a follow-up appointment. By this time, the swelling should have gone down, and specialist will be able to put the bone in place more accurately.

Fractures of the bones inside your nose (ethmoid fractures) require hospitalization.

Jaw (mandibular) fracture

A broken bone that is visible through the skin or inside the mouth, called an open fracture, requires hospital admission and IV antibiotics.

Most of the time, if you have a closed fracture of your jaw, you will be referred to an oral surgeon for treatment.

Midface (maxillary) fracture

Because of the severity of a midface fracture and its associated injuries, you may require a tube to be inserted to help you breathe, and you will most likely be hospitalized.

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These fractures usually require surgery that's typically performed by a plastic surgeon or ENT specialist.

Cheekbone (zygomatic) fracture

If your zygomatic arch is fractured and if the fracture is pushed in causing a cosmetic defect, you may require surgery to repair it.

Eye socket (orbital) fracture

The timing of and need for eye socket fracture repair is controversial. Some specialists feel surgical repair is needed only if you have persistent double vision or your eye recedes into the socket. Others use CT scans to help them make the decision. You should consult with the specialist whether to have surgery or not.

Temporomandibular joint dislocation

This is usually realigned in the emergency department. A local anesthetic can be used as well as medication to relax the jaw muscles.

Next Steps - Prevention

These injuries are often associated with alcohol use and fighting, motor vehicle accidents, and playing sports.

Always wear your seatbelt while driving and use proper protective gear for sports.

Outlook

Nasal fracture

You will require follow-up care in 5-7 days for re-evaluation after the swelling has subsided. If your nose needs to be put back into place, it is usually done at this visit.

Jaw (mandibular) fracture

Prognosis is usually good.

Midface (maxillary) fracture

People with midface fractures have a poorer prognosis because of other injuries suffered from the accident that caused their fracture.

A high incidence of blindness is reported with a particular type of maxillary fracture.

Cheekbone (zygomatic) fracture

As an isolated injury, this usually presents a cosmetic problem only.

Temporomandibular joint dislocation

Be careful not to open your mouth widely after your jaw is put back into place because of the risk of another dislocation of the joint.

Synonyms and Keywords

broken nose, broken jaw, jaw fracture, mandibular fracture, maxillary fracture, nasal fracture, orbital floor fracture, TMJ dislocation, zygomatic fracture, facial trauma, nose bleed, nose bleeds, nosebleed, nosebleeds, nasal bleeding, bloody nose

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