Facial bone fracture

Disease Description (Causes and Symptoms)

• Definition: A condition in which the facial bones (facial skeleton) are fractured due to external impact (such as a traffic accident, fall, assault, or sports injury) or a lesion (such as a cyst or tumor).
• Pathophysiology: Structural deformity caused by displacement of the periosteum and fracture fragments can result in bleeding, soft-tissue injury, nerve and vascular damage, and functional disorders of the orbit, alveolar bone, and temporomandibular joint. Mandibular fractures can cause malocclusion and difficulty opening and closing the mouth, while orbital fractures can cause diplopia, restricted eye movement, and enophthalmos (sunken eye).
• Main symptoms: Facial bleeding, swelling, and lacerations; pain; malocclusion; loose or lost teeth; sensory disturbances (tingling or numbness); limited mouth opening and closing and difficulty chewing; speech abnormalities; diplopia (in orbital fractures); and mobility of fracture fragments (when palpated).

Treatment Methods

• Initial care: Secure the airway (immediate cardiopulmonary resuscitation and, if necessary, tracheostomy in cases of breathing difficulty), apply pressure and control bleeding, apply ice, administer pain medication and antibiotics, and provide dental emergency care if damaged teeth are to be preserved.
• Nonsurgical treatment: If the fracture fragments are minimally displaced and stable, the upper and lower jaws are aligned and immobilized in occlusion using intermaxillary fixation (IMF), arch bars, or similar devices (typically maintained for several weeks, with adjustments based on the patient's age and symptoms).
• Surgical treatment: For severely displaced fractures, open reduction and internal fixation (ORIF) is performed—fracture sites are reduced and fixed using metal plates and screws or resorbable plates. Orbital fractures may require orbital floor reconstruction (using an implant or membrane) and restoration of entrapped muscles.
• Medication: Antibiotics (when wounds or oral contamination are present), pain relievers, and tetanus prevention when necessary.
• Postoperative care: Monitor for infection and bleeding. Swelling and bruising generally improve within several weeks (typically 3–4 weeks). Limit excessive mouth opening and hard foods, and maintain oral hygiene. Removal of metal plates is generally not required; it may be considered when clinically necessary.
• Prognosis: Functional and cosmetic recovery is possible with appropriate reduction and fixation. Delayed treatment may result in malocclusion, chronic pain, facial asymmetry, sensory disturbances, or nonunion.

Checklist Before an Outpatient Visit (Including Sample Questions)

Items and records to prepare:

• When and how the injury occurred and the circumstances of the injury
• Current symptoms (bleeding, pain, visual disturbance, sensory changes, ability to open and close the mouth, etc.) and records of symptom changes
• Current medications (including anticoagulants and antithrombotic agents), allergies (especially to antibiotics and anesthetics), and chronic diseases (such as heart disease and diabetes)
• Previous dental or facial surgery records and recent radiographs (if available)
• Photos of the injured area (from multiple angles if possible) Sample questions:
• When exactly did the injury occur, and what was the condition at the time (consciousness, presence of bleeding)?
• What difficulties are you currently having with eating, swallowing, or speaking?
• Have you experienced any changes in vision (diplopia or restricted visual field), ear pain, or discharge?

General Sample Questions to Ask the Doctor

• What is the exact location and severity of my fracture? (Request an explanation of the CT findings.)
• Is surgery necessary? Is nonsurgical treatment possible? What are the advantages and disadvantages of each option?
• What complications are expected with surgery, and what is the recovery period (length of hospital stay and restrictions on eating and exercise)?
• If I am currently taking any medications (such as anticoagulants), how should they be adjusted?

Sample Questions Specific to the Condition

• (If a mandibular fracture is suspected) Is there a risk that malocclusion will remain in my case? How long will intermaxillary fixation (IMF) need to be maintained?
• (If an orbital fracture is suspected) How likely are restricted eye movement or diplopia to persist, and how is the need for orbital reconstruction determined on CT?

Summary of Additional Precautions:

• If emergency signs such as breathing difficulty, progressive loss of vision, severe bleeding, altered consciousness, high fever, pallor, or severe pain occur, immediately visit an emergency department or call 119.
• Following post-treatment instructions (such as adhering to the immobilization period, maintaining oral hygiene, taking antibiotics and pain relievers, and restricting hard foods) is important for preventing complications and achieving a good prognosis.