Midface trauma

Alternative names 
Maxillofacial injury; Facial trauma; Facial injury; LeFort injuries

Definition
Facial trauma is any injury of the face and upper jaw bone.

Causes, incidence, and risk factors
Blunt or penetrating trauma can cause injury to the midface region, which includes the upper jaw (maxilla). Common causes of facial injury include:

     
  • Automobile accidents  
  • Violence  
  • Penetrating injuries

Symptoms
Findings with trauma in this region include:

     
  • Difficulty breathing through the nose due to swelling and bleeding in the nasal region.  
  • Changes in sensation and feeling over the face  
  • Swelling around the eyes may cause limitations in vision.  
  • Double vision  
  • Missing teeth

Signs and tests
On physical exam:

     
  • Lacerations (breaks in the skin) are often seen.  
  • Bruising around the eyes and/or widening of the distance between the eyes may indicate injury to the bones between the eye sockets.  
  • When the upper jaw moves with the head stabilized, there may be a fracture in this area.  
  • Abnormal sensations on the cheek and irregularities that can be felt on the facial region can indicate fractures.  
  • The physical exam is often complemented by a CT scan of the head.

Treatment
When the patient is unable to perform any normal function, or a substantial cosmetic deformity occurs, the treatment is usually surgical. Goals include:

     
  • Establish a clear airway.  
  • Control bleeding.  
  • Treat the fracture.  
  • Rule out other injuries.  
  • Fix broken bone segments with titanium plates and screws.  
  • Use existing lacerations and incisions in the mouth and around the eye and scalp during surgery to minimize scarring.  
  • Treatment should be immediate, as long as the patient is stable and cleared of all life-threatening injuries and the neck has been cleared of fractures.

Expectations (prognosis)
Patients generally do very well with proper pre-operative workup and planning. The patient should be forewarned that they will most likely look different from their pre- injury state and that additional surgeries may be necessary 6-12 months later.

Complications
General complications include, but are not limited to:

     
  • Bleeding  
  • Infection  
  • Neurologic complications  
  • Facial asymmetry

Calling your health care provider
Go to the emergency room or call the local emergency number (such as 911) if you have a severe injury to your face.

Prevention
Wear seat belts and use protective head gear when appropriate. Avoid triggering potentially violent confrontations with other people.

Johns Hopkins patient information

Last revised: December 2, 2012
by Arthur A. Poghosian, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.