Maxillofacial Trauma

Professionals who treat facial trauma must be well versed in emergency care, acute treatment and long term reconstruction and rehabilitation – not just for physical reasons but emotional as well. Oral and Maxillofacial Surgeons are trained, skilled and uniquely qualified to manage and treat Facial Trauma. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.

Dr. Smith is a member of the active medical staff of the Memorial Hospital in North Conway, NH. He delivers emergency room coverage for facial injuries, which include the following conditions.

• Facial lacerations
• Intra oral lacerations
• Avulsed (knocked out) and displaced teeth
• Fractured facial bones (cheek, nose or eye socket)
• Fractured jaws (upper and lower jaw)

Many of these injuries may also involve other dental specialists to repair fractured teeth, perform root canal therapy on injured teeth, or help align misplaced teeth. Dr. Smith will communicate and work with any or all of these dental professionals to help coordinate your necessary treatment after such an injury.

The Nature of Maxillofacial Trauma

There are a number of possible causes of facial trauma. Motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work related injuries. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face. Typically, facial injuries are classified as soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).

Soft Tissue Injuries of the Maxillofacial Region

When soft tissue injuries such as lacerations occur on the face, they are repaired by suturing. In addition to the obvious concern of providing a repair that yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures underneath the surface such as facial nerves, salivary glands and salivary ducts (or outflow channels). Dr. Smith is a well-trained, board certified oral and maxillofacial surgeon and is proficient at diagnosing and treating all types of facial lacerations.

Bone Injuries of the Maxillofacial Region

Fractures of the bones of the face are treated in a manner similar to the bone fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, the age and general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.

One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved site. This technique of treatment can often allow for healing and obviates the necessity of having the jaws wired together. This technique is called "rigid fixation" of a fracture. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly.

The treatment of facial fractures should be accomplished in a thorough and predictable manner. More importantly, the patient's facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always made. As many of the repair procedures as possible will be performed from inside the mouth. At the same time, the incisions that become necessary outside the mouth are designed to be small and, whenever possible, are placed so that the resultant scar is hidden.

Injuries to the Teeth and Surrounding Dental Structures

Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, do not attempt to wipe the tooth off or wash it, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. It needs to be kept wet and not allowed to dry off. It should be submerged in saliva or milk. It should never be placed in plain water, boiling water, mouthwash, or alcohol as that would kill the cells on the root surface. It does not need to be frozen or kept on ice. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. Therefore, the patient should see a dentist or oral surgeon as soon as possible. Finally, other dental specialists are usually called upon to help save these traumatically injured teeth. Root canal therapy will be necessary and that will be performed by an endodontist or your general dentist. It is your general dentist who will repair or rebuild any fractured teeth or place crowns on teeth after root canal therapy. In the event that injured teeth cannot be saved or repaired, dental implants are frequently utilized as replacements for teeth that are lost from traumatic injuries.

The proper treatment of facial injuries is now the realm of specialists who are well versed in emergency care, acute treatment, long term reconstruction and rehabilitation of the patient.