Facial Trauma
Oral and maxillofacial surgeons are trained, skilled and uniquely qualified to manage and treat facial trauma. They are experts in treating fractures of the upper and lower jaws, cheeks, nose, orbits, and the cosmetic management of facial lacerations. Their knowledge of how jaws come together (dental occlusion) is critical when repairing complex facial fractures. In fact, the American College of Surgeons’ guidelines for optimal care require Level I and II trauma centers, those that treat the most serious and complex facial trauma patients, to have oral and maxillofacial surgeons on call to perform complex reconstruction of the maxillofacial and craniofacial complex, including the mouth, face and jaws. Moreover, many of the techniques that are standard in today’s hospital emergency rooms were developed by oral and maxillofacial surgeons in combat hospitals during World War II, Korea, Vietnam and today’s international conflicts.Dr. Vahadi is on staff at Torrance Memorial Medical Center and provides coverage for facial injuries, which include the following conditions:
- Facial lacerations
- Intra-oral lacerations
- Dental injuries such as avulsed (knocked out) or displaced teeth
- Fractured jaws (upper and lower jaw)
- Fractured facial bones (cheek, nose or eye socket)
The Nature of Maxillofacial Trauma
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. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face. Typically, facial injuries are classified as soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).
Soft Tissue Injuries of the Maxillofacial Region
Soft tissue injuries such as lacerations that occur on the face 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).
Bone Injuries of the Maxillofacial Region
Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, the age, and general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.
One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique of treatment can often allow for healing and obviates the necessity of having the jaws wired together. This technique is called “rigid fixation” of a fracture. The development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly.
The treatment of facial fractures should be accomplished in a thorough and predictable manner. More importantly, the patient’s facial appearance should be minimally affected. 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.
Injuries to the Teeth & Surrounding Dental Structures
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral & maxillofacial surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be placed in salt water or milk. The sooner the tooth is reinserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Never attempt to wipe the tooth off, since remnants of the ligaments that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as an endodontist, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often utilized as replacements for missing teeth.
Prevention — The Best Policy
Because avoiding injury is always best, oral and maxillofacial surgeons advocate the use of automobile seat belts, protective mouth guards, and appropriate masks and helmets for everyone who participates in athletic pursuits at any level. You don’t have to play at the professional level to sustain a serious head injury. New innovations in helmet and mouth and face guard technology have made these devices comfortable to wear and very effective in protecting the vulnerable maxillofacial area. Make sure your family is well protected. If you play the sport, make the following safety gear part of your standard athletic equipment:
Football: Helmets with face guards and mouth guards should be worn. Many of the helmets manufactured for younger players have plastic face guards that can be bent back into the face and cause injury. These should be replaced by carbon steel wire guards.
Baseball: A catcher should always wear a mask. Batting helmets with a clear molded plastic face guard are now available; these can also be worn while fielding.
Soccer: Soccer players should wear mouth guards for protection. Oral and maxillofacial surgeons advise goalies to also wear helmets.
Biking: All riders should wear lightweight bike helmets to protect their heads. Scooters and Skateboarders: Bike helmets are also recommended for those who ride two-wheeled scooters and skateboards.
Skiing and Snowboarding: The recent surge in accidents among skiers and snowboarders has encouraged many safety conscious participants to wear lightweight helmets that will protect the maxillofacial area in the event of a fall or crash.
Horseback Riding: A helmet and mouth guard is recommended for horseback riding, particularly if the rider is traveling cross-country or plans to jump the horse.
Ice Hockey: Many ice hockey players are beginning to wear cage-like face guards attached to their helmets. These are superior to the hard plastic facemasks worn by some goalies, as the face guard and the helmet take the pressure of a blow instead of the face. For extra protection, both face and mouth guards — including external mouth guards made of hard plastic and secured with straps — can be worn.
Wrestling: More and more high school athletic associations require wrestlers to wear headgear. A strap with a chin cup holds the gear in place and helps steady the jaw. Recently, facemasks have been developed for wrestlers, who should also wear mouth guards.
Boxing: Mouth guards are mandatory in this sport. A new pacifier-like mouth guard for boxers has been designed with a thicker front, including air holes to aid breathing.
Lacrosse: Hard plastic helmets resembling baseball-batting helmets, with wire cage facemasks, are manufactured for this sport.
Field Hockey: Oral and maxillofacial surgeons recommend that athletes participating in this sport wear mouth guards. Goalies can receive extra protection by wearing Lacrosse helmets.
Basketball, Water Polo, Handball, Rugby, Karate, Taekwondo, Judo, Jujitsu, and Gymnastics: Participants in these sports should be fitted with mouth guards.
A Word about Mouth Guards
New synthetic materials and advances in engineering and design have produced mouth guards that are sturdier yet lightweight enough to allow the wearer to breathe easily. Mouth guards can vary from the inexpensive “boil and bite” models to custom-fabricated guards made by dentists, which can be adapted to the sport and are generally more comfortable.
A mouth guard should be evaluated from the standpoint of retention, comfort, ability to speak and breathe, tear resistance and protection provided to the teeth, gums and lips.
There are five criteria to consider when being fitted for a mouth guard. The appliance should be:
- Fitted so that it does not misalign the jaw and throw off the bite
- Lightweight
- Strong
- Easy to clean
- Should cover the upper and/or lower teeth and gums
By encouraging sports enthusiasts at every level of play to wear mouth guards and other protective equipment, oral and maxillofacial surgeons hope to help change the “face” of sports.
In the event a facial or mouth injury occurs that requires a trip to the emergency room, the injured athlete, his or her parent or coach should be sure to ask that an oral and maxillofacial surgeon is called for consultation. With their background and training, oral and maxillofacial surgeons are the specialists most qualified to deal with these types of injuries. In some cases, they may even detect a “hidden” injury that might otherwise go unnoticed.
