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.