Facial Trauma

Facial trauma repair involves surgically realigning fractured facial bones using plates and screws or wiring, and repairing soft tissue injuries with stitches, skin grafts, or tissue transfers. Treatment aims to restore the face's natural architecture and function, with approaches tailored to the injury's severity.

Initial Evaluation and Treatment Planning

• Assessment:

A surgeon evaluates the full extent of the injury, examining both bone fractures and soft tissue damage, including nerves, salivary ducts, and the eyes. 

• Airway Protection:

Ensuring a secure airway is a critical first step, especially in severe facial trauma. 

• Timing:

Early repair, ideally within hours or days of the injury, generally leads to better functional and aesthetic outcomes. 

Bone Repair

• Closed Reduction:

In some cases, especially with minor fractures, bones can be realigned manually without surgery. 

• Open Reduction and Internal Fixation (ORIF):

For more serious fractures, surgery is required to open the area, realign the bones, and stabilize them with plates and screws, often made of titanium. 

• Wiring:

Jaw fractures may be temporarily wired shut to ensure proper healing and stabilization. 

• Bone Grafts:

For large structural defects, bone grafts are used to provide support and fill missing sections of bone. 

Soft Tissue Repair

• Laceration Repair: Cuts and lacerations are typically treated with stitches (suturing). 
• Grafting: Large areas of severe soft tissue loss may require skin or tissue grafts from another part of the body. 
• Nerve Repair: Injuries to facial nerves require direct repair to restore function and sensation. 

CHEEK BONE FRACTURE Also known as ZYGOMATIC BONE

A zygomatic bone fracture is a break in the cheekbone, also known as the malar or zygomatic bone. These are the second most common facial fractures, most often caused by blunt-force trauma from assaults, sports injuries, motor vehicle accidents, or falls. The severity of the fracture can vary from a simple crack to a severely displaced, multi-fragmented injury. 

The zygomatic bone plays a critical role in facial structure by protecting the eye and forming the prominence of the cheek. Damage to this bone can cause both cosmetic and functional problems. 

Symptoms

Symptoms can range from mild discomfort to severe functional impairment, depending on the severity and location of the fracture. 

• Pain and swelling: Immediate tenderness and swelling in the cheek and under the eye are common.
• Facial flattening or asymmetry: A noticeably flattened or sunken appearance of the cheekbone may be visible, especially when viewed from above or below.
• Numbness (paresthesia): Numbness in the cheek, side of the nose, upper lip, or upper teeth can occur if the infraorbital nerve, which runs through the bone, is damaged.
• Vision problems:
  • Double vision (diplopia): Can result if the eye muscles or the orbital floor are affected.
  • Sunken eyeball (enophthalmos): May occur with significant fractures of the orbital floor.
• Difficulty chewing or opening the mouth (trismus): A displaced zygomatic bone can interfere with the movement of the lower jaw, making chewing and opening the mouth painful or difficult.
• Bruising (ecchymosis): Bruising around the eye (periorbital ecchymosis) and on the whites of the eye (subconjunctival hemorrhage) is a frequent sign. 

Treatment

Treatment options depend on the fracture's severity and displacement. 

Conservative management

For non-displaced or minimally displaced fractures, surgery may not be necessary.

• Observation: The fracture is monitored closely.
• Diet: Patients are advised to eat a soft diet to avoid putting pressure on the healing bone.
• Pain management: Analgesics are used to control pain. 

Surgical intervention

Surgery is typically required for displaced fractures to restore both facial appearance and function.

• Closed reduction: A minimally invasive procedure where the fracture is realigned using a special instrument inserted through a small skin incision or through the mouth.
• Open Reduction and Internal Fixation (ORIF): For more severe or complex fractures, the bone is surgically exposed, repositioned, and secured with titanium plates and screws.
• Multi-point fixation: Depending on the fracture, a surgeon may fix the bone at two or three points (e.g., at the frontozygomatic suture, infraorbital rim, and zygomaticomaxillary buttress) for maximum stability.