FACIAL-BONE FRACTURE |
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General Information
DEFINITION--A complete or incomplete break in one or several bones in the face.
BODY PARTS INVOLVED
Facial bones: upper jaw (maxilla), cheek bones, malar and other bones that form the eye sockets (orbits), and nose. (See also Jaw Fracture.)
Joints between bones listed above.
Teeth.
Eyes and nose.
Soft tissue around the fracture site, including nerves, tendons, ligaments, periosteum (covering to bone), blood vessels and connective tissue.
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SIGNS & SYMPTOMS
Severe pain at the injury site.
Swelling and bruising of soft tissue around the fracture, including black eyes.
Visible deformity if the fracture is complete and bone fragments separate enough to distort normal facial contours.
Tenderness to the touch.
Numbness around the fracture site.
Bleeding from the nose or eye.
CAUSESDirect blow to the face.
RISK INCREASES WITH
Contact sports, especially boxing, wrestling and baseball.
Cycling.
Poor nutrition, especially calcium deficiency.
If surgery or anesthesia are needed, surgical risk increases with smoking and use of drugs, including mind-altering drugs, muscle relaxants, antihypertensives, tranquilizers, sleep inducers, insulin, sedatives, beta-adrenergic blockers or corticosteroids.
HOW TO PREVENTWear protective face masks and headgear when cycling or competing in contact sports. The use of protective equipment has significantly decreased the incidence of facial fractures.
WHAT TO EXPECT
APPROPRIATE HEALTH CARE
Doctor's treatment. A plastic surgeon, oral surgeon, ophthalmologist, or ear, nose and throat specialist may be consulted.
Surgery (sometimes) to realign fractured bones and reconstruct normal facial contours.
Self-care during rehabilitation.
DIAGNOSTIC MEASURES
Your own observation of symptoms.
Medical history and physical exam by a doctor.
X-rays of the skull and facial bones.
Laboratory studies to measure blood loss.
CAT scan (See Glossary) to rule out brain injury.
Vision examination.
POSSIBLE COMPLICATIONS
AT THE TIME OF FRACTURE:
Shock.
Pressure on or injury to eyes, nose, nearby nerves, ligaments, tendons, blood vessels or connective tissues.
Breathing obstruction. AFTER TREATMENT OR SURGERY:
Excessive bleeding.
Impaired blood supply to the healing bone.
Avascular necrosis (death of bone cells) due to interruption of the blood supply.
Infection introduced during surgical treatment.
Unstable or arthritic jaw or neck joints following repeated injury.
PROBABLE OUTCOME
Surgery usually restores normal features and facial function.
Teeth that have been knocked out can sometimes be replanted (see Tooth Injury & Loss). Speech will be changed while the wires are in place, but it should return to normal when they are removed.
Normal vision should return if the eye is not injured.
Recovery usually takes about 6 weeks. Healing is considered complete when there is no pain at the fracture site and when X-rays show complete bone union.
HOW TO TREAT
NOTE -- Follow your doctor's instructions. These instructions are supplemental.
FIRST AID
If the victim is wearing a face mask, cut it away.
Check for excessive bleeding and swelling that may cause breathing obstruction. If the victim is not breathing, administer cardiopulmonary resuscitation (CPR).
Apply ice packs to the face to decrease swelling and pain.
Elevate the upper body so the face is above the level of the heart. This reduces swelling and prevents accumulation of excess fluid. Use pillows to prop the head if you are sure there is no neck injury.
Keep the person warm with blankets to decrease the possibility of shock.
CONTINUING CARE
A broken jaw is corrected by securing the teeth with wire or plastic splints so the jaw heals in its proper position.
Surgery is frequently necessary to realign facial bones and restore a normal appearance. For best results it should be done as soon as possible after injury. DURING CONVALESCENCE:
Don't exercise to the point that you must pant for breath, because breathing may be difficult for a while.
Protect the face from pressure. Sleep on your back.
Don't blow your nose hard or use makeup until healing is complete.
If your jaws are wired, learn how to release them quickly in case of emergency, such as severe coughing or vomiting.
MEDICATIONYour doctor may prescribe:
Pain relievers.
Antibiotics to fight infection if necessary.
ACTIVITYRest quietly for about 2 days, then resume your normal activities as strength returns.
DIET
Drink only water before manipulation or surgery to treat the fracture. Solid food in your stomach makes vomiting while under anesthesia more hazardous.
Eat a high-protein, liquid diet for several days. If your jaw is wired, a liquid diet will be necessary for up to 8 weeks. Add soft solid foods as you are able.
REHABILITATIONNone.
CALL YOUR DOCTOR IF
You or someone else have signs or symptoms of a facial-bone fracture.
The following occurs after treatment:
Fever.
Impaired vision.
Severe headache.
Loss of sensation in the face.
Intolerable pain.
Upper-respiratory illness of any kind during healing. This increases the danger of infection.
Loosening of wires or splints.
New, unexplained symptoms. Drugs used in treatment may produce side effects.
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