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.