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Common Facial Bone Fractures

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Facial fractures involve the breaking of the bones that involve the face above the neck region. Read about common facial fractures and their treatment.

Medically reviewed by

Dr. Infanteena Marily F.

Published At January 18, 2022
Reviewed AtAugust 1, 2023

Introduction:

Bone injuries or fractures to the orofacial region due to trauma result in facial destruction and deformity. Traumatic accidents, sudden impact from round or sharp objects, head and neck injuries, and several multifactorial causes of facial fractures have a severe and sometimes potentially life-altering impact on the individual’s physical and mental health.

What Are Facial Fractures?

Facial fractures refer to the breaking or fracturing of bones in the face due to traumatic injuries, such as accidents, falls, or physical assaults. The face is a complex structure composed of numerous bones that protect vital organs and support sensory functions, including vision, hearing, and breathing. Common facial fractures involve the nose, cheekbones (zygomatic bones), jaw (mandible), and the bones surrounding the eyes (orbital bones).

What Are the Symptoms of Facial Fractures?

Symptoms of facial fractures may include pain, swelling, bruising, deformity, and difficulty moving the affected area. Treatment for facial fractures depends on their location and severity but may involve immobilization, surgical realignment, and careful monitoring to ensure proper healing and restore normal facial function and appearance. Early diagnosis and prompt medical attention are essential to prevent potential complications and achieve optimal outcomes for individuals with facial fractures.

Which Are the Most Common Facial Fractures and Its Types?

Depending on the break in the bone continuity, it is classified as partial or complete fractures. They are also categorized based on the intensity or forceful impact of the traumatic factor, region affected, and the extent of deformity. Facial fractures mainly can be categorized into the following groups as these groups of bones are particularly prone to fractures.

  • Trauma to the base of the skull (cerebrospinal rhinorrhoea).

  • Blow-out fractures (orbital fractures).

  • Zygomatic arch fractures.

  • Le Fort fractures (maxillary fractures).

  • Nasal bone fractures.

 What is Cerebrospinal Rhinorrhea?

This is a traumatic fracture linked to the impact upon the anterior part of the skull base leading to nasal bone fracture that in turn causes the cerebrospinal fluid (CSF) to leak through the nose. The CSF leak contents can be diagnostically detected by Fehling’s solution, which tests sugar positive, conclusive of CSF leak. The characteristic feature is that the CSF obtained does not contain mucus or albumin.

The main complication of this fracture in the long term is the possibility of “recurrent meningitis” infection due to leakage of CSF that eventually heals but forms an internal tract.

  • Management - Cerebrospinal rhinorrhea is usually addressed by the physician without any nasal packing and a heavy dose of antibiotics for 2 to 3 weeks till it heals completely. If the cerebrospinal fluid leak is suspected to be a serious issue from a physician’s perspective with diagnostic radiography [CT (computed tomography) or MRI (magnetic resonance imaging)], surgical procedures like craniotomy followed by facial graft insertion are recommended to rectify it usually.

What Are Blow-Out Fractures or Orbital Fractures?

This kind of facial fracture is caused due to the orbital edge or orbital rim impacted upon by a rounded object with traumatic force. This instantly results in the contents of the orbit being pushed backwards and the inferior orbital wall almost immediately collapsing and fracturing (the inferior orbital wall is considered the weakest fracture point to trauma). CT scan and tomography are useful radiographic modalities for determining the extent of displacement or fracture site examination. Patients affected complain of double vision often (diplopia) due to the displacement of orbital contents; the orbitalis muscle can malfunction and volume changes are observed as well (enophthalmos).

The posterior displacement of the eyeball poses a great risk to its functionality which can have psychosomatic impact on the affected individual’s health.

  • Management - Either using an incision over the lower eyelid or through the transantral route, the eyeball contents are successfully repositioned back into the orbit which is the main surgical treatment for posterior displacement fractures. Septal cartilage grafts are also used to supplement the floor of the orbit alternatively with a silastic or polythene sheet as well.

What Are Zygomatic Fractures?

Commonly referred in medical literature as malar-zygomatic fractures, zygomatic bone fracture of the face not only produces external deformity but on clinical examination by the physician, the fracture line tends to be obvious on palpation as well. Epistaxis (nose bleed), ecchymosis (skin discoloration with bruising in this fracture especially near the lower eyelids), numbness on the part of face below the orbit region (infraorbital numbness), double vision or diplopia, may be present upon clinical examination.

Trismus or limited jaw movements causes the patient discomfort while chewing, eating, and drinking. In severe cases, cheek swelling may further complicate the traumatic impact faced.

  • Management - Paranasal sinus radiography is diagnostically indicated to visualize the extent of fracture in the zygomatic bones (unilaterally or bilaterally). The recommended radiographic modalities being occipitomental, occipitofrontal, and submentovertex views (for observing if the fracture extends to the orbital margins). An oral and maxillofacial surgeon is capable of dealing effectively with zygomatic bone fractures with surgical procedure like open reduction or elevation of the fractured segments into the temporalis fascia and into the zygomatic arch.

What Is A Maxillary Fracture?

Maxillary fractures are a combination of fracture lines (which can hence be more traumatic of all the facial fractures) or lines of impact extending through the nasomaxillary complex, malar zygomatic complex, and the maxilla itself. Depending on the severity and extent of trauma caused, craniofacial distortion is also possible with these fractures. Nasal obstruction, double vision or diplopia, and improper biting with external facial deformities are the signs clinically assessed by the physicians. Classified by Le Fort in 1901, Le Fort fractures or maxillary fractures are mainly graded into three categories;

  • Le Fort 1 Fracture or Guerin's Fracture - Lower maxillary fracture (of the tooth bearing segment of the maxilla).

  • Le Fort 2 Fracture - Fracture involving both sides of the face (the frontal, nasal, lacrimal, and the orbital process may be involved bilaterally).

  • Le Fort 3 Fracture - The facial bones (of the middle of the face) and the cranium may be separated. Craniofacial fractures can be life-threatening.

  • Management - As maxillary fractures if untreated on time may prove life-threatening, airway maintenance and bleeding control hold value to the ailing patient’s life. Oral and maxillofacial surgeons prefer surgical management of the fracture with reduction of the displaced fragments along with interdental wiring, head caps, or crossbars to not only correct the bite dentally but also to fuse the bony fragments to unite with the cranium (in severe fractures).

What Is A Nasal Bone Fracture?

This fracture to the nasal bones or the nasal bridge can cause both nasal bleed (epistaxis) and nasal obstruction. The commonest of traumatic fractures is the displacement of bone that depends on the direction and force of blow caused to the nose.

  • Management - An individual affected by a nasal fracture should be immediately admitted or reported to the physician as manual correction of deformities is possible under general anesthesia only before edema (swelling) sets in. Once the edema starts, then repositioning of the fractured fragments using the forehead as a horizon is done under general anesthesia. Nasal wiring and supplementation of the wire with lead plates on either side of the fractured nose may prove beneficial in repositioning the fracture segments (in severe cases).

Conclusion:

In conclusion, facial fractures necessitate immediate attention from healthcare professionals to ensure proper evaluation and management. Seeking the expertise of maxillofacial or plastic surgeons is crucial in assessing the extent of the injury and promptly initiating facial reconstruction. By addressing these fractures promptly, healthcare providers or orthopedic surgeon can not only restore facial functionality but also play a pivotal role in preserving the affected individual's self-confidence and overall psychosomatic well-being. Timely and comprehensive care remains essential in achieving the best possible outcomes and helping patients regain their quality of life after such traumatic events.

Frequently Asked Questions

1.

Which Facial Bone Is the Most Fragile Facial Bone?

The nasal bone is the most fragile facial bone. It can fracture in case of trauma or damage because it is placed at the peak of the nose. These fractures can cause pain, swelling, and nasal deformities. Treatment options for a broken nasal bone can range from conservative measures, such as ice and pain relief, to surgical intervention in severe cases.

2.

How Does Smith's Fracture Look?

A Smith's fracture is characterized by a break at the top of the ankle, with the bone fragments pointing downwards. It is sometimes referred to as an inverted ankle fracture. Swelling, discomfort, and trouble bearing weight on the affected foot are common side effects of this type of fracture. A deformity may be visible in severe cases, and the foot may appear rotated inwards. Diagnosis is usually made through physical examination and imaging studies such as X-rays.

3.

Can Facial Bone Fractures Heal Without Treatment?

Most facial bone fractures can heal on their own with proper care. However, the treatment plan for a facial bone fracture will depend on the severity and location of the injury. In some cases, such as with severe fractures or fractures that affect the function of the face, surgery may be required for proper healing. Additionally, over-the-counter pain relievers, ice, and rest can help to manage symptoms and promote healing.

4.

How Doctors Treat a Broken Cheekbone?

The treatment for a broken cheekbone will depend on the severity of the injury. In mild cases, treatment may include:
- Over-the-counter pain relievers.
- Ice packs to reduce swelling.
- Keeping the head elevated.
- Resting the face.
- Wearing a splint or cast.
- Physical therapy to regain facial muscle strength.
- Stitches or other wound care for any cuts.

5.

What Is the Time Required to Heal Fractured Facial Bones?

The time taken by the facial bone fracture to heal can vary depending on various factors, such as severity and location of the injury, the patient's overall health, and the type of treatment received. On average, most facial bone fractures take four to six weeks to heal. However, more severe fractures requiring surgery can take several months to heal fully.

6.

How Much Time Required In Healing of Maxillary Fractures?

Maxillary fractures, or fractures of the upper jawbone, typically take several weeks to several months to heal. However, the exact amount of time will depend on the severity of the fracture, the type of treatment received, and the patient's overall health. For example, most maxillary fractures treated with surgery or other medical intervention take four to six weeks to heal, while more severe fractures may take several months. In some cases, additional treatments such as physical therapy or orthodontic work may be necessary to regain the face full function and aesthetic appearance.

7.

How to Diagnose a Maxillary Fracture?

Assessment of a maxillary fracture involves the physical examination of the face, jaw, and mouth and imaging studies such as X-rays, CT (computed tomography) scans, or MRI (magnetic resonance imaging) scans. Pain and swelling management may also be done, such as pain relievers and ice packs. In addition, a neurological examination is sometimes performed to check for nerve or muscle damage. Based on the assessment results, a doctor can determine the type and severity of the fracture and develop a treatment plan.

8.

Can Maxillary Fracture Heal Without Treatment?

Sometimes a maxillary fracture may heal independently, but this is not common. Instead, most maxillary fractures require medical intervention for proper healing. The treatment type will depend on the severity of fracture and the extent of injury. Treatment options may include surgery, wearing a splint or cast, physical therapy, or other medical interventions.

9.

Does Every Facial Fracture Require Surgery?

Not all cheekbone fractures require surgery. The degree and location of the injury, the patient's age and general health, and the patient's symptoms will all influence the type of treatment for a cheekbone fracture. For most cheekbone fractures, treatment may involve wearing a splint or cast, over-the-counter pain relievers, ice packs, and rest to manage symptoms and promote healing. However, in some cases, such as with severe fractures or fractures that affect the function of the face, surgery may be required for proper healing.

10.

How Long Does a Facial Fracture Hurt?

The length of time a facial fracture will cause pain can vary depending on several factors, including the injury's type and severity, the fracture's location, and the type of treatment received. Most facial fractures will generally cause pain for several days to several weeks after the injury. During this time, cold packs and over-the-counter painkillers can assist to control the pain. However, if the facial fracture is severe or requires surgery, the pain may last several weeks to several months. The pain may also be accompanied by swelling, bruising, and other symptoms in these cases.

11.

How to Treat Facial Fractures?

Treatment for facial fractures depends on the severity and location of the injury. Common treatments include non-surgical measures such as wearing a splint or cast, pain management, and rest. However, surgery may be required for severe fractures that affect the face's function. Physical therapy may also be recommended after surgery or for certain fractures. Therefore, seeking medical attention for proper diagnosis and treatment is important.

12.

Does Fractured Cheekbone Occurs Without Symptoms?

Yes, it is possible to have a fractured cheekbone and not know it. Some people may experience only mild symptoms, such as pain and swelling, after a cheekbone fracture, which can be mistaken for a less serious injury. In some cases, there can be no visible symptoms or signs of a cheekbone fracture, especially if the fracture is small or does not displace the bone.

13.

How Serious Is a Nasal Fracture?

A nasal fracture can range in severity from a minor injury to a more serious type and location and complex fracture. The severity of a nasal fracture will depend on the injury, as well as the patient's overall health. In general, a minor nasal fracture that does not displace the bone or cause any significant changes in the appearance or function of the nose is considered a relatively minor injury. However, a more severe nasal fracture involving multiple bones or affecting the nose's function may require surgery and a longer recovery time.

14.

Is Nasal Bone Fracture a Type of an Emergency?

A nasal bone fracture is not considered an emergency, but it is essential to get medical advice as soon as possible after an injury. While some minor nasal fractures may not cause any significant changes in the appearance or function of the nose, a more severe fracture may require prompt treatment to prevent complications and promote proper healing.

15.

What Is the Healing Duration of Nasal Bone Fracture?

The healing time for a nasal bone fracture can vary, and it depends on the severity of the injury and the type of treatment received. On average, most people expect to experience some improvement within the first one to second weeks after the injury. However, complete healing can take weeks to months, especially if the fracture is severe or requires surgery
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Dr. Achanta Krishna Swaroop
Dr. Achanta Krishna Swaroop

Dentistry

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le fort fracturesfacial bone fracture
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