Facial Bone Fractures

Breaks in the bones of the face resulting from trauma or injury

Table of Contents

Overview

Facial bone fractures are breaks in any of the bones that make up the face. These injuries can range from simple, isolated fractures to complex injuries involving multiple bones and associated soft tissue damage. The face contains 14 bones that protect vital structures including the eyes, nose, and mouth, while also providing the framework for facial appearance and expression.

The most commonly fractured facial bones include the nasal bones (the most frequent), followed by the zygomatic (cheekbone), mandible (lower jaw), and maxilla (upper jaw). Orbital fractures affecting the eye socket are also common and can have serious implications for vision. Due to the complex anatomy of the face and its proximity to important structures like the brain, airway, and major blood vessels, facial fractures require careful evaluation and management.

These injuries typically result from high-impact trauma and can have significant functional and aesthetic consequences if not properly treated. Modern surgical techniques have greatly improved outcomes, but prompt recognition and appropriate treatment remain crucial for optimal recovery and minimizing long-term complications.

Symptoms

The symptoms of facial bone fractures vary depending on which bones are affected and the severity of the injury. Many symptoms appear immediately after trauma, while others may develop over hours or days.

Common General Symptoms

  • Facial pain - Often severe and localized to the fracture site
  • Swelling and bruising - May obscure the underlying injury
  • Lip swelling - Common with lower face injuries
  • Facial deformity or asymmetry
  • Tenderness to touch
  • Difficulty opening mouth
  • Numbness or tingling

Eye-Related Symptoms

Nasal Symptoms

  • Redness in or around nose
  • Nosebleeds (epistaxis)
  • Difficulty breathing through nose
  • Nasal deformity or deviation
  • Crepitus (crackling sound) when touching nose

Jaw-Related Symptoms

  • Difficulty chewing or biting
  • Teeth misalignment (malocclusion)
  • Jaw deviation when opening mouth
  • Inability to close mouth properly
  • Loose or missing teeth

Associated Symptoms

  • Headache
  • Peripheral edema - Swelling extending beyond the face
  • Clear fluid drainage from nose (possible CSF leak)
  • Hearing problems
  • Dizziness or balance issues

Causes

Facial bone fractures result from trauma that exceeds the strength of the facial bones. The force required varies depending on the bone involved and the individual's bone density.

Common Causes

Motor Vehicle Accidents

  • Car crashes - Most common cause of severe facial fractures
  • Motorcycle accidents - Often result in multiple fractures
  • Bicycle accidents - Especially without helmet use
  • Pedestrian injuries

Interpersonal Violence

  • Physical assault
  • Domestic violence
  • Gunshot wounds
  • Stab wounds

Falls

  • Falls from height
  • Ground-level falls - Especially in elderly
  • Stairs-related falls
  • Workplace accidents

Sports Injuries

  • Contact sports - Boxing, martial arts, rugby
  • Ball sports - Baseball, hockey, basketball
  • Extreme sports
  • Recreational activities

Contributing Factors

  • Alcohol use - Impairs judgment and coordination
  • Substance abuse - Increases risk-taking behavior
  • Osteoporosis - Weakens bones
  • Previous facial surgery - May create weak points
  • Pathological conditions - Bone tumors or cysts

Risk Factors

Several factors increase the likelihood of sustaining facial bone fractures.

Demographic Factors

  • Male gender - 3-4 times higher risk than females
  • Young adults - Peak incidence in 20-30 year olds
  • Elderly individuals - Higher risk from falls
  • Children - Different fracture patterns due to developing bones

Behavioral Risk Factors

  • Alcohol abuse - Major risk factor for trauma
  • Drug use - Impairs judgment and reflexes
  • Aggressive behavior - Increases violence exposure
  • Risk-taking activities

Environmental Factors

  • Occupation - Construction, law enforcement, military
  • Urban residence - Higher violence and accident rates
  • Socioeconomic factors - Limited access to safety equipment
  • Season - Increased during summer months

Medical Conditions

Activity-Related Risks

  • Contact sports participation
  • Not wearing protective equipment
  • Driving without seatbelts
  • Riding motorcycles without helmets

Diagnosis

Accurate diagnosis of facial fractures requires careful clinical evaluation and appropriate imaging studies to determine the extent of injury and plan treatment.

Initial Assessment

Primary Survey

  • Airway evaluation and protection
  • Breathing assessment
  • Circulation and hemorrhage control
  • Neurological evaluation
  • Cervical spine assessment

History Taking

  • Mechanism of injury
  • Loss of consciousness
  • Visual symptoms
  • Dental occlusion changes
  • Previous facial injuries or surgeries

Physical Examination

Inspection

  • Facial asymmetry or deformity
  • Lacerations or abrasions
  • Ecchymosis patterns
  • Eye position and movement
  • Dental alignment

Palpation

  • Step-offs or irregularities
  • Point tenderness
  • Crepitus
  • Mobility of bone segments
  • Sensory function testing

Imaging Studies

CT Scan

  • Gold standard for facial fracture diagnosis
  • Multiplanar reconstructions
  • 3D reconstructions for surgical planning
  • Evaluates both bone and soft tissue

Plain Radiographs

  • Limited use in modern practice
  • May be used for isolated nasal fractures
  • Panoramic views for mandible fractures

MRI

  • Soft tissue evaluation
  • Optic nerve assessment
  • Brain injury evaluation

Special Tests

  • Forced duction test - For orbital fractures
  • Visual acuity testing
  • Dental examination
  • Nasal endoscopy
  • Nerve conduction studies - If indicated

Treatment Options

Treatment of facial fractures depends on the location, severity, and associated injuries. Goals include restoring function, preventing complications, and achieving acceptable cosmetic results.

Initial Management

  • Airway management - May require intubation
  • Hemorrhage control - Direct pressure, nasal packing
  • Pain management - Appropriate analgesia
  • Tetanus prophylaxis - If indicated
  • Antibiotic therapy - For contaminated wounds

Conservative Treatment

Suitable for non-displaced or minimally displaced fractures:

  • Observation and monitoring
  • Soft diet for jaw fractures
  • Ice application for swelling
  • Head elevation
  • Activity restrictions
  • Nasal decongestants for nasal fractures

Surgical Treatment

Indications for Surgery

  • Displaced fractures
  • Functional impairment
  • Cosmetic deformity
  • Orbital floor fractures with entrapment
  • Open fractures

Surgical Techniques

  • Open reduction and internal fixation (ORIF) - Using plates and screws
  • Closed reduction - For nasal fractures
  • Maxillomandibular fixation - For jaw fractures
  • Bone grafting - For comminuted fractures
  • Endoscopic repair - For selected cases

Timing of Surgery

  • Immediate - Open fractures, severe hemorrhage
  • Early (24-72 hours) - Most fractures
  • Delayed (7-14 days) - After swelling resolution
  • Secondary reconstruction - For complications or poor outcomes

Post-Treatment Care

  • Regular follow-up appointments
  • Oral hygiene maintenance
  • Dietary modifications
  • Physical therapy if needed
  • Scar management
  • Psychological support

Complications Management

  • Infection - Antibiotics, drainage
  • Malunion - May require revision surgery
  • Nerve injury - Observation or repair
  • Diplopia - Prism glasses, surgery
  • Chronic sinusitis - Medical or surgical management

Prevention

While not all facial fractures can be prevented, many can be avoided through safety measures and lifestyle modifications.

Vehicle Safety

  • Always wear seatbelts
  • Use appropriate child safety seats
  • Wear helmets when riding motorcycles or bicycles
  • Avoid distracted driving
  • Never drive under the influence
  • Maintain vehicle safety features

Sports Safety

  • Wear appropriate protective equipment
  • Use face guards and helmets
  • Follow sport-specific safety rules
  • Proper training and conditioning
  • Mouthguards for contact sports

Home and Work Safety

  • Remove tripping hazards
  • Install handrails on stairs
  • Ensure adequate lighting
  • Use safety equipment at work
  • Follow workplace safety protocols
  • Non-slip surfaces in bathrooms

Violence Prevention

  • Avoid high-risk situations
  • Seek help for domestic violence
  • Anger management programs
  • Conflict resolution skills
  • Community violence prevention programs

Lifestyle Modifications

  • Limit alcohol consumption
  • Avoid illicit drug use
  • Manage medical conditions affecting balance
  • Regular vision checks
  • Maintain bone health

When to See a Doctor

Facial trauma should always be evaluated by a healthcare professional, but certain symptoms require immediate emergency care.

Seek Emergency Care Immediately For:

  • Difficulty breathing or airway compromise
  • Uncontrolled bleeding
  • Loss of consciousness
  • Clear fluid draining from nose or ears
  • Vision loss or severe visual changes
  • Inability to open or close mouth
  • Severe facial deformity
  • Signs of brain injury

Seek Urgent Medical Attention For:

  • Double vision
  • Numbness in face
  • Teeth not fitting together properly
  • Significant facial swelling
  • Eye movement problems
  • Severe pain not controlled by over-the-counter medication
  • Suspected nasal fracture

Follow-up Care Needed If:

  • Persistent pain after initial treatment
  • Worsening swelling
  • Development of fever
  • Drainage from surgical sites
  • Changes in bite or vision
  • Concerns about healing or appearance

Frequently Asked Questions

How long does it take for facial fractures to heal?

Healing time varies depending on the fracture location and treatment method. Simple nasal fractures may heal in 3-4 weeks, while complex fractures requiring surgery typically take 6-8 weeks for initial bone healing. Complete healing and resolution of swelling can take several months. Children generally heal faster than adults, and following post-treatment instructions is crucial for optimal healing.

Will I need plastic surgery after a facial fracture?

Not all facial fractures require plastic surgery. Many can be treated successfully by oral and maxillofacial surgeons or otolaryngologists. However, plastic surgery may be beneficial for complex fractures with significant soft tissue damage, fractures causing cosmetic deformity, or secondary reconstruction if the initial results are unsatisfactory. The need for plastic surgery is determined case by case.

Can facial fractures cause permanent damage?

While most facial fractures heal well with appropriate treatment, some can result in permanent complications. These may include chronic pain, nerve damage causing numbness, vision problems, breathing difficulties, or cosmetic deformity. The risk of permanent damage increases with fracture severity, delayed treatment, and complications like infection. Early, appropriate treatment minimizes these risks.

When can I return to sports after a facial fracture?

Return to sports depends on the fracture type, treatment received, and sport involved. Generally, non-contact activities can resume after 4-6 weeks for simple fractures. Contact sports typically require 8-12 weeks or longer, especially for fractures involving the nose, orbit, or jaw. Always get medical clearance before returning to sports, and consider protective equipment to prevent re-injury.

Are facial fractures more serious in children?

Facial fractures in children require special consideration because their facial bones are still developing. While children's bones heal faster, fractures can affect growth centers and future facial development. Additionally, children have different fracture patterns due to their more flexible bones and different facial proportions. Pediatric facial fractures should be managed by specialists experienced in treating children.

References

  1. Ellis E 3rd, et al. Contemporary Management of Facial Trauma. J Oral Maxillofac Surg. 2023.
  2. Kellman RM. Maxillofacial Trauma. In: Cummings Otolaryngology. 7th ed. Elsevier; 2021.
  3. American Association of Oral and Maxillofacial Surgeons. Facial Trauma. Updated 2023.
  4. Erdmann D, et al. A retrospective analysis of facial fracture etiologies. Ann Plast Surg. 2008;60(4):398-403.
  5. Gassner R, et al. Cranio-maxillofacial trauma: a 10 year review. J Craniomaxillofac Surg. 2003;31(1):51-61.
  6. AO Foundation. Principles of Facial Fracture Management. Updated 2023.