Health Topics: /Facial injuries

At one time or another, everyone has had a minor facial injury that caused pain, swelling, or bruising. Home treatment is usually all that is needed for mild bumps or bruises.

Facial injuries most commonly occur during:

·         Sports or recreational activities, such as ice hockey, basketball, rugby, soccer, or martial arts.

         Motor vehicle crashes.

·         Falls.

·         Fights.

In children, most facial injuries occur during sports or play or are caused by falls. Minor facial injuries in young children tend to be less severe than similar facial injuries that occur in older children or adults. Young children are less likely to break a facial bone because they have fat pads that cushion their faces and their bones are more flexible. But young children are more likely to be bitten in the face by an animal.

Head injuries may occur at the same time as a facial injury, so be sure to check for symptoms of a head injury. For more information, see the topicHead Injuries, Age 3 and Younger or Head Injuries, Age 4 and Older.

Facial injuries may be caused by a direct blow, penetrating injury, or fall. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

·         A cut or puncture to your face or inside your mouth. This often occurs with even a minor injury. But a cut or puncture is likely to occur when a jaw or facial bone is broken. The bone may come through the skin or poke into the mouth.

·         Bruises  from a tear or rupture of small blood vessels under the skin.

·         Broken bones, such as a fractured cheekbone 

·         A dislocated jaw, which may occur when the lower jawbone (mandible) is pulled apart from one or both of the joints connecting it to the base of the skull at the temporomandibular (TM) joints. This can cause problems even if the jaw pops back into place.

Treatment for a facial injury may include first aid measures, medicine, and in some cases surgery. Treatment depends on:

·         The location, type, and severity of the injury.

·         How long ago the injury occurred.

·         Your age, health condition, and other activities, such as work, sports, or hobbies.

When you have had a facial injury, it is important to look for signs of other injuries, such as a spinal injuryeye injury, or an injury to themouth, such as a cut lip or injured tooth.

Check Your Symptoms

Call 911 anytime you think you may need emergency care. For example, call if:

·         You have a seizure.

·         You passed out (lost consciousness).

·         You have tingling, weakness, or numbness on one side of your body.

Call your doctor now or seek immediate medical care if:

·         You have a severe headache.

·         You develop double vision.

·         You have a fever and stiff neck.

·         Clear, watery fluid drains from your nose.

·         You feel dizzy or lightheaded.

·         You have new eye pain or changes in your vision, such as blurring.

·         You have new ear pain, ringing in your ears, or trouble hearing.

·         You are confused, irritable, or not acting normally.

·         You have a hard time standing, walking, or talking.

·         You have new mouth or tooth pain, or you have trouble chewing.

·         You have increasing pain even after you have taken your pain medicine.

Watch closely for changes in your health, and be sure to contact your doctor if:

·         You develop a cough, cold, or sinus infection.

·         The symptoms from your injury are not steadily improving.

Facial Injuries

The face is the most vulnerable area of the body and is usually the least protected. Sports-related facial injuries account for 8% of all facial soft tissue injuries. Approximately 11-40% of all sports injuries involve the face. These injuries are most often due to direct hits with a ball or player-to-player contacts. Health-care providers for athletes should be familiar with the anatomy of the facial region, the most common types of facial injuries, and the initial management of facial injuries.

The most common types of sports-related facial trauma are the soft tissue injuries and the fractures of the "T-Zone" bones (the nose, the zygoma, and the mandible). These injuries often occur in combination. Depending on the extent and the types of injury, some injuries can be managed at the sporting event site, with the athlete resuming play immediately. Other injuries may demand transfer to an urgent care setting and management by a specialist.

Facial injuries include injuries involving the mouth, face and jaw. These range from facial cuts and lacerations to more serious problems, such as broken teeth and facial bones.

Bone fractures can involve the lower or upper jaw, palate, cheekbones and eye sockets. These injuries often occur during automobile accidents, sports or recreational activities, fights or assaults, work-related tasks, projects around the house or accidental falls.

Many patients with facial injuries are first seen in the emergency room and then referred to an oral and maxillofacial surgeon or a plastic surgeon for further treatment.


Symptoms may include:

·         Difficulty breathing, seeing, talking or swallowing

·         Facial swelling or misshapen face

·         Cut or puncture wound on your face

·         Facial pain

·         Bruising or discoloration behind your ears, eyes or under your tongue

·         Widening of the distance between your eyes, which may indicate injury to your eye sockets

·         Facial numbness or tingling

·         Skin infections or rashes

·         When making a diagnosis, your doctor will begin by asking about your medical history, including any events that may have caused your facial injury. A thorough physical and medical examination will also be conducted, to note any injuries to your face and other parts of your body. Many people with facial injuries also suffer from additional medical problems.

 

Causes of facial injuries

Facial injuries most commonly occur during:

·         Sports or recreational activities, such as ice hockey, basketball, rugby, soccer, or martial arts.

·         Work-related tasks or projects around the home.

·         Motor vehicle crashes.

·         Falls.

·         Fights.

In children, most facial injuries occur during sports or play or are caused by falls. Minor facial injuries in young children tend to be less severe than similar facial injuries that occur in older children or adults. Young children are less likely to break a facial bone because they have fat pads that cushion their faces and their bones are more flexible. But young children are more likely to be bitten in the face by an animal.

Head injuries may occur at the same time as a facial injury, so be sure to check for symptoms of a head injury. For more information, see the topic Head Injuries, Age 3 and Younger orHead Injuries, Age 4 and Older.

Types of injuries

Facial injuries may be caused by a direct blow, penetrating injury, or fall. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

·           A cut or puncture to your face or inside your mouth. This often occurs with even a minor injury. But a cut or puncture is likely to occur when a jaw or facial bone is broken. The bone may come through the skin or poke into the mouth.

·           Bruises from a tear or rupture of small blood vessels under the skin.

  • Broken bones, such as a fractured cheekbone .
  • A dislocated jaw, which may occur when the lower jawbone (mandible) is pulled apart from one or both of the joints connecting it to the base of the skull at the temporomandibular (TM) joints. This can cause problems even if the jaw pops back into place.

 Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerationsand bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries. Symptoms are specific to the type of injury; for example, fractures may involve pain, swelling, loss of function, or changes in the shape of facial structures.

Facial injuries have the potential to cause disfigurement and loss of function; for example, blindness or difficulty moving the jaw can result. Although it is seldom life-threatening, facial trauma can also be deadly, because it can cause severe bleeding or interference with the airway; thus a primary concern in treatment is ensuring that the airway is open and not threatened so that the patient can breathe. Depending on the type of facial injury, treatment may include bandaging and suturing of open wounds, administration of ice, antibiotics and pain killers, moving bones back into place, and surgery. When fractures are suspected, radiography is used for diagnosis. Treatment may also be necessary for other injuries such as traumatic brain injury, which commonly accompany severe facial trauma.

In developed countries, the leading cause of facial trauma used to be motor vehicle accidents, but this mechanism has been replaced by interpersonal violence; however auto accidents still predominate as the cause in developing countries and are still a major cause elsewhere. Thus prevention efforts include awareness campaigns to educate the public about safety measures such as seat belts and motorcycle helmets, and laws to prevent drunk and unsafe driving. Other causes of facial trauma include falls, industrial accidents, and sports injuries.

Causes

Injury mechanisms such as falls, assaults, sports injuries, and vehicle crashes are common causes of facial trauma in children as well as adults. Blunt assaults, blows from fists or objects, are a common cause of facial injury.Facial trauma can also result from wartime injuries such as gunshots and blasts. Animal attacks and work-related injuries such as industrial accidents are other causes. Vehicular trauma is one of the leading causes of facial injuries. Trauma commonly occurs when the face strikes a part of the vehicle's interior, such as the steering wheel.In addition, airbags can cause corneal abrasions andlacerations (cuts) to the face when they deploy.

Signs and symptoms

Fractures of facial bones, like other fractures, may be associated with pain, bruising, and swelling of the surrounding tissues (such symptoms can occur in the absence of fractures as well). Fractures of the nose, base of the skull, or maxilla may be associated with profuse nosebleeds. Nasal fractures may be associated with deformity of the nose, as well as swelling and bruising. Deformity in the face, for example a sunken cheekbone or teeth which do not align properly, suggests the presence of fractures. Asymmetry can suggest facial fractures or damage to nerves.People with mandibular fractures often have pain and difficulty opening their mouths and may have numbness in the lip and chin With Le Fort fractures, the midface may move relative to the rest of the face or skull.

Diagnosis

Radiography, imaging of tissues using X-rays, is used to rule out facial fractures. Angiography (X-rays taken of the inside of blood vessels) can be used to locate the source of bleeding. However the complex bones and tissues of the face can make it difficult to interpret plain radiographs; CT scanning is better for detecting fractures and examining soft tissues, and is often needed to determine whether surgery is necessary, but it is more expensive and difficult to obtain. CT scanning is usually considered to be more definitive and better at detecting facial injuries than X-ray. CT scanning is especially likely to be used in people with multiple injuries who need CT scans to assess for other injuries anyway.

Causes

Injury mechanisms such as falls, assaults, sports injuries, and vehicle crashes are common causes of facial trauma in children as well as adults. Blunt assaults, blows from fists or objects, are a common cause of facial injury. Facial trauma can also result from wartime injuries such as gunshots and blasts. Animal attacks and work-related injuries such as industrial accidents are other causes. Vehicular trauma is one of the leading causes of facial injuries. Trauma commonly occurs when the face strikes a part of the vehicle's interior, such as the steering wheel.In addition, airbags can cause corneal abrasions andlacerations (cuts) to the face when they deploy.

Signs and symptoms

Fractures of facial bones, like other fractures, may be associated with pain, bruising, and swelling of the surrounding tissues (such symptoms can occur in the absence of fractures as well). Fractures of the nose, base of the skull, or maxilla may be associated with profuse nosebleeds. Nasal fractures may be associated with deformity of the nose, as well as swelling and bruising. Deformity in the face, for example a sunken cheekbone or teeth which do not align properly, suggests the presence of fractures. Asymmetry can suggest facial fractures or damage to nerves. People with mandibular fractures often have pain and difficulty opening their mouths and may have numbness in the lip and chin. With Le Fort fractures, the midface may move relative to the rest of the face or skull.

Diagnosis

Radiography, imaging of tissues using X-rays, is used to rule out facial fractures.Angiography (X-rays taken of the inside of blood vessels) can be used to locate the source of bleeding.[16] However the complex bones and tissues of the face can make it difficult to interpret plain radiographs; CT scanning is better for detecting fractures and examining soft tissues, and is often needed to determine whether surgery is necessary, but it is more expensive and difficult to obtain. CT scanning is usually considered to be more definitive and better at detecting facial injuries than X-ray.CT scanning is especially likely to be used in people with multiple injuries who need CT scans to assess for other injuries anyway.

 Image result for facial injuryImage result for facial injuryImage result for facial injuryImage result for facial injuryImage result for facial injury

 

Home Treatment

Home treatment may help treat problems and prevent complications after an injury to your face.

First aid for bleeding

Facial injuries can bleed a lot even if they are minor injuries. Stop any bleeding from the nose camera.gifmouth, or face so you can see what the injury is. Crying increases blood flow to the face and can make a nosebleed or facial bleeding worse. If your injured child is crying, speak in a quiet, relaxed manner to soothe him or her.

First aid for a suspected broken bone

  • Do not move misshapen facial bones. It may make an injury worse, increase bleeding, or cause more problems.
  • Apply an ice or cold pack immediately to prevent or minimize swelling.
  • Seek medical evaluation and treatment.

Measures to reduce pain, swelling, and bruising

  • Use ice. Cold will reduce pain and swelling. Apply an ice or cold packimmediately to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. After 48 to 72 hours, if swelling is gone, apply warmth to the area that hurts.
  • Keep your head elevated, even while you sleep. This will help reduce swelling.
  • For the first 48 hours, avoid things that might increase swelling, such as hot showers, hot tubs or hot packs, or drinking alcohol or hot fluids.
  • Do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) for the first 24 hours. Aspirin prolongs the clotting time ofblood and may cause more nose or facial bleeding.
  • Eat soft foods and cold foods and fluids to reduce jaw and mouthpain. Avoid hot foods or beverages, which may increase swelling around the mouth.

    Facial Injury
    Treatment

    Treatment for facial injuries varies, depending on the location and severity of your injury. Patients with facial injuries may additional medical problems. Your doctor will coordinate the care of these medical conditions with the necessary specialists.

    If you have broken bones in your face, the bones must be lined up and held in place long enough to heal properly. Depending on the severity of the injury and your age, this may take six or more weeks.

    Repositioning and holding your broken bones in place may be achieved by a variety of techniques. For extensive facial injuries, incisions to expose the bones and then a combination of wiring and plating techniques may be used. Fractures of the upper and lower jaw may require metal braces that are fastened to your teeth with rubber bands or wires to hold your jaws together.

    Patients with partial or full teeth loss may need dentures or specially designed splints to align and secure their fracture.

    In most cases, surgery for facial injuries requires a hospital stay. Your jaw's normal functions and range of movements may be restricted, especially in cases when your jaw is wired shut. In these instances, you will have to follow a special diet to encourage healing. After you are discharged from the hospital, your surgeon will give you specific instructions for a special diet and caring for your injury.

    Severe facial cuts and lacerations may require microvascular reconstructive surgery — a technique for rebuilding the face and neck using blood vessels, bone and tissue, including muscle and skin from other parts of the body — by a plastic surgeon.

  • Treatment

    Treatment for a facial injury may include first aid measures, medicine, and in some cases surgery. Treatment depends on:

    • The location, type, and severity of the injury.
    • How long ago the injury occurred.
    • Your age, health condition, and other activities, such as work, sports, or hobbies.

    When you have had a facial injury, it is important to look for signs of other injuries, such as a spinal injuryeye injury, or an injury to the mouth, such as a cut lip or injured tooth.

  • Causes

    Injury mechanisms such as falls, assaults, sports injuries, and vehicle crashes are common causes of facial trauma in children as well as adults. Blunt assaults, blows from fists or objects, are a common cause of facial injury.Facial trauma can also result from wartime injuries such as gunshots and blasts. Animal attacks and work-related injuries such as industrial accidents are other causes.Vehicular trauma is one of the leading causes of facial injuries. Trauma commonly occurs when the face strikes a part of the vehicle's interior, such as the steering wheel.In addition, airbags can cause corneal abrasions andlacerations (cuts) to the face when they deploy.

    Signs and symptoms

    Bruising, a common symptom in facial trauma

    Fractures of facial bones, like other fractures, may be associated with pain, bruising, and swelling of the surrounding tissues (such symptoms can occur in the absence of fractures as well). Fractures of the nose, base of the skull, or maxilla may be associated with profuse nosebleeds. Nasal fractures may be associated with deformity of the nose, as well as swelling and bruising. Deformity in the face, for example a sunken cheekbone or teeth which do not align properly, suggests the presence of fractures. Asymmetry can suggest facial fractures or damage to nerves. People with mandibular fractures often have pain and difficulty opening their mouths and may have numbness in the lip and chin. With Le Fort fractures, the midface may move relative to the rest of the face or skull.

    Diagnosis

    Radiography, imaging of tissues using X-rays, is used to rule out facial fractures.Angiography (X-rays taken of the inside of blood vessels) can be used to locate the source of bleeding. However the complex bones and tissues of the face can make it difficult to interpret plain radiographs; CT scanning is better for detecting fractures and examining soft tissues, and is often needed to determine whether surgery is necessary, but it is more expensive and difficult to obtain.CT scanning is usually considered to be more definitive and better at detecting facial injuries than X-ray. CT scanning is especially likely to be used in people with multiple injuries who need CT scans to assess for other injuries anyway.

    Prevention

    Measures to reduce facial trauma include laws enforcing seat belt use and public education to increase awareness about the importance of seat belts and motorcycle helmets. Efforts to reduce drunk driving are other preventative measures; changes to laws and their enforcement have been proposed, as well as changes to societal attitudes toward the activity. Information obtained frombiomechanics studies can be used to design automobiles with a view toward preventing facial injuries. While seat belts reduce the number and severity of facial injuries that occur in crashes,airbags alone are not very effective at preventing the injuries. In sports, safety devices including helmets have been found to reduce the risk of severe facial injury. Additional attachments such as face guards may be added to sports helmets to prevent orofacial injury (injury to the mouth or face). mouth guards also used,

  • Treatment

    An immediate need in treatment is to ensure that the airway is open and not threatened (for example by tissues or foreign objects), because airway compromisation can occur rapidly and insidiously, and is potentially deadly.Material in the mouth that threatens the airway can be removed manually or using a suction tool for that purpose, and supplemental oxygen can be provided. Facial fractures that threaten to interfere with the airway can be reduced by moving the bones back into place; this both reduces bleeding and moves the bone out of the way of the airway. Tracheal intubation (inserting a tube into the airway to assist breathing) may be difficult or impossible due to swelling. Nasal intubation, inserting an endotracheal tube through the nose, may be contraindicated in the presence of facial trauma because if there is an undiscovered fracture at the base of the skull, the tube could be forced through it and into the brain. If facial injuries prevent oraotracheal or nasotracheal intubation, asurgical airway can be placed to provide an adequate airway. Although cricothyrotomy and tracheostomy can secure an airway when other methods fail, they are used only as a last resort because of potential complications and the difficulty of the procedures.

    Sutures may be used to close wounds.

    A dressing can be placed over wounds to keep them clean and to facilitate healing, and antibiotics may be used in cases where infection is likely People with contaminated wounds who have not been immunized against tetanus within five years may be given a tetanus vaccination.Lacerations may require stitches to stop bleeding and facilitate wound healing with as little scarring as possible. Although it is not common for bleeding from the maxillofacial region to be profuse enough to be life-threatening, it is still necessary to control such bleeding.Severe bleeding occurs as the result of facial trauma in 1–11% of patients, and the origin of this bleeding can be difficult to locate. Nasal packing can be used to control nose bleeds and hematomas that may form on the septum between the nostrils.Such hematomas need to be drained. Mild nasal fractures need nothing more than ice and pain killers, while breaks with severe deformities or associated lacerations may need further treatment, such as moving the bones back into alignment and antibiotic treatment.

    Treatment aims to repair the face's natural bony architecture and to leave as little apparent trace of the injury as possible. Fractures may be repaired with metal plates and screws.They may also be wired into place. Bone grafting is another option to repair the bone's architecture, to fill out missing sections, and to provide structural support. Medical literature suggests that early repair of facial injuries, within hours or days, results in better outcomes for function and appearance.

    Surgical specialists who commonly treat specific aspects of facial trauma are oral and maxillofacial surgeons. These surgeons are trained in the comprehensive management of trauma to the lower, middle and upper face and have to take written and oral board examinations covering the management of facial injuries.

    Prognosis and complications

    Diagram of lateral view of face showing the imaginary line between the tragus of the ear and the middle of the upper lip. The middle third of this line is the approximate location of the course of the parotid duct. If facial lacerations cross this line, there is a risk that the parotid duct is damaged.

    By itself, facial trauma rarely presents a threat to life; however it is often associated with dangerous injuries, and life-threatening complications such as blockage of the airway may occur. The airway can be blocked due to bleeding, swelling of surrounding tissues, or damage to structures.Burns to the face can cause swelling of tissues and thereby lead to airway blockage.Broken bones such as combinations of nasal, maxillary, and mandibular fractures can interfere with the airway. Blood from the face or mouth, if swallowed, can cause vomiting, which can itself present a threat to the airway because it has the potential to beaspirated. Since airway problems can occur late after the initial injury, it is necessary for healthcare providers to monitor the airway regularly.

    Even when facial injuries are not life-threatening, they have the potential to cause disfigurement and disability, with long-term physical and emotional results.Facial injuries can cause problems with eye, nose, or jaw function[12] and can threaten eyesight. As early as 400 BC, Hippocrates is thought to have recorded a relationship between blunt facial trauma and blindness. Injuries involving the eye or eyelid, such as retrobulbar hemorrhage, can threaten eyesight; however, blindness following facial trauma is not common.

    Incising wounds of the face may involve the parotid duct. This is more likely if the wound crosses a line drawn between the tragus of the ear to the upper lip. The approximate location of the course of the duct is the middle third of this line.

    Nerves and muscles may be trapped by broken bones; in these cases the bones need to be put back into their proper places quickly.For example, fractures of the orbital floor or medial orbital wall of the eye can entrap the medial rectus or inferior rectus muscles. In facial wounds, tear ducts and nerves of the face may be damaged. Fractures of the frontal bone can interfere with the drainage of the frontal sinus and can cause sinusitis.

    Infection is another potential complication, for example when debris is ground into an abrasion and remains there.Injuries resulting from bites carry a high infection risk.

  • Image result for facial injury

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