Facial Fracture
Facial fracture or trauma is also known as maxillofacial trauma which is any form of physical trauma to the face. It can be due to the injuries to the soft tissues which includes burns, lacerations, bruises and fractures to the facial bones like the nasal bone, jaw and even the eye. The fracture can even bring change in shape and disfigure the face and even hamper the normal functioning like there can be difficulty in opening and closing of the mouth and even cause blindness. In severe cases it might even be fatal as it may cause heavy bleeding and can also block the airway blocking the passage of air and the patient may stop breathing.
Signs and Symptoms
The general symptoms of fracture may be visible as it is also a form of fracture like bruises, swelling and tenderness, etc. If the nose and maxilla gets fractured and the base of the skull gets fractured, then bleeding from the nose might be observed. The facial bones may also get dis-aligned like cheekbones may get sunken and the teeth may get misaligned which makes it difficult for the patient to move the jaw. The lips may get numbed. The mid facial portion may get moved from the rest of the facial portion.
The airway gets blocked and threatened due to different factors like the broken bones may get in the airway, excessive bleeding also sometimes blocks the passage and sometimes due to the swelling of the soft tissues the passage gets blocked. In other case the blood from the face and mouth gets swallowed by the patient and in the fractured condition causes vomiting in the patient and this can too cause blockage of the airway due to aspiration. Hence it is very important for the airway to be monitored as the blockade may occur even after a long time due to various reasons and is unpredictable.
The facial trauma can cause misalignment of the facial bones and even can cause blindness. The parotid duct can also cause incision to the wounds on the face. Sometimes the nerves get trapped in the broken bones and so the surgeon prefers to move the bones to their specified position as soon as possible and it also suggested that the treatment should be done at the earliest. It can also damage the lacrimal system and the nerves associated with the system. The drainage of the frontal sinuses can get interfered with the fracture of the frontal bone.
Procedure
The first thing to be taken care of while facial fracture treatment is that the airway is not to be blocked and the patient should be able to breathe. The debris or fluid material in the mouth should be removed either manually using hand and if not possible then suction tool can be used for the removal purpose and while this process supplementary oxygen to the patient is to be provided which is continued if required. In order to stop the bleeding and to remove the blockade from the airway the broken bones are moved to their specific places. Tracheal intubation in most of the cases is not possible due to swelling in the airway. Nasal intubation is also prevented as an undiscovered fracture in the base of the skull may lead the tube to be pushed into the brain. When the injury prevents orotracheal and nasotracheal intubation then a surgical airway is made for adequate passage of air. At extreme cases the methods of facial fracture treatment used as last resort to the problem are cricothyrotomy and tracheostomy as these two methods can secure an airway and can overcome potential complications and difficulties.
Dressing is done after facial trauma surgery to keep the wounds clean and it also facilitates healing. If infections are seemed to occur, then antibiotics are given to the patient and also tetanus vaccine if the patient has not been vaccinated with it in the last five years. The lacerations after facial trauma surgery are treated by stitching which facilitates healing of the wound and also stops bleeding but leaves scars. Nose bleeding is stopped by using nasal packing. And the hematomas formed on the septum between the nostrils are drained to be treated. In severe cases the maxillofacial bleeds and the origin of the bleeding region is difficult to locate.
In some case the fracture is also repaired using metal plates and screws mainly made of titanium. In some resorbable materials are also used which are biologically degraded and can be removed over time. When some parts go missing then bone grafting method is used to support the natural architecture of the face and to fill out the missing section. The earlier the treatment is the better the results are. The facial fracture treatment in India besides aiming for treating the injury also aims to revive the aesthetics of the face and to gain back the architecture of the face as was in the time before the trauma.
Description
The face contains different types of bones and is divided into many parts. And so the facial trauma does not cause injury to the face as a whole but may also cause damage to its different parts and so in medical sciences the trauma has been divided into many parts and so also the facial fracture treatment methods in order to treat the injury and to give back the face the pre trauma aesthetics and architecture.
- Frontal Fracture has two parts the anterior and the posterior and the facial fracture treatment method has prioritized the regions for treatment. The anterior part can be delayed a bit but the posterior part needs to be treated immediately as it requires neurosurgical evaluations. In this facial trauma surgery antibiotics is not necessarily given but only if required.
- Orbital Fracture has the supportive facial fracture treatment methods which include elevation of the head, ice and analgesics. This form of fracture includes inferior rectus muscle entrapment, inferior orbital nerve entrapment, enophthalmos, orbital dystopia, etc. These may cause cosmetic damage i.e. misalignment, functional defect and the treatment should not be delayed more than 24 hours. The orbital fractures which harm the sinuses are to be given antibiotic prophylaxis. The surgical repair may include diplopia which persists two weeks after the injury, large fractures and enophthalmos.
- Nasal Fracture, an angulated of this one can be reduced by exerting firm and quick pressure with thumbs towards the midline or sometimes if it does not work then soft probe can be used to elevate the depression or deviate the septum. Other form of facial fracture treatment includes analgesics and epistaxis. Surgery required is performed only after the swelling and edema are reduced. Any open wounds are given antibiotics.
- Zygomatic or zygomaticomaxillary fracture is treated by open reduction and internal fixation for restoring the normal contour.
- Maxillary Fracture: while treating this the consultation from a neurosurgeon is preferred. If the fracture extends through the jaw, nasal or sinus mucosa then prophylactic antibiotic is prescribed.
- Mandibular Fracture while treating this mostly antibiotics like penicillin or clindamycin are used as these mostly occur in the tooth bearing regions.
Recovery Time
The recovery time for facial trauma surgery in India depends on the type of fracture the patient has suffered and also the different types of symptoms suffered from in the fracture.
The bruises and the swelling takes two to three weeks to get settled down or healed. After this amount of time, the body starts healing from inside and the internal injuries starts healing.
In the frontal fracture or nasal fracture after the facial fracture treatment when the soft tissues get treated there may be a short term pain and a feeling of numbness and alteration of sensation may be felt. Depending on the position of the injury the time for healing of this alteration of sensation may vary from weeks to months to vanish completely.
In case of nasal fracture, the patient is advised not to blow the nose for the next ten days from the treatment as it may force air into the sinuses. It takes around 2 weeks to be healed completely.
The maxillary fracture takes around six to eight weeks to be healed and within this period the patient is advices not to face any knocks and bumps for better healing.
The intake of antibiotics if prescribed should be done as per the prescription as it varies from the types of fractures and also from person to person.
Facial trauma surgery cost
The facial trauma surgery cost depends on the severity of the fracture and the part to be treated. At an average rate the price of the facial trauma treatment in India ranges from INR 70,000 to INR 5,00,000.
FAQs
Why is the numbness in my face persisting?
The numbness is nothing to worry about, it persists for couple of days after treatment and will vanish soon. Apply ice pack for relief.
Is any kind of precursor or treatment is required or not for the numbness?
No, it is not needed. It will get settled within a few days.
Is it possible to treat the axial instability?
No, it is not preferred.
After treating the trauma is it safe to move in public transport system?
Yes, you can move after about 6 to 8 weeks depending on the settlement from the after effect.
Is the treatment have any side effect if I have sensitive skin?
No, it do not have such kind of side effect.
Is laser treatment more efficient or the manual is to be preferred first?
It depends on the problem to be treated.
Will I have facial paralysis after the treatment?
No, not at all.