Fractures of the bones of the face appear for a number of reasons, most often associated with sports. They may be the result of contact between athletes (head, fist, elbow), contact with equipment and gear (ball, puck, steering wheel, gym equipment) or contact with the environment or obstacles (trees, walls). In some sports (football, baseball, hockey) there is a high percentage of facial injuries.
Bone fractures
The facial section of the skull has a complex structure. It consists of the frontal bone, zygomatic, orbital bones, nasal, maxillary and mandibular and other bones. Some of them are located deeper in the facial structure. Muscles are attached to these bones, providing processes of chewing, swallowing and speech.
One of the most common facial bone fractures is a nose fracture. Injury to other bones may also occur. One bone or several can be broken. Multiple fractures more often result from a car or other accident. Fractures can be unilateral (occur on one side of the face) or bilateral (on both sides of the face). Below you can see on the photo fractures of the facial bones.
Is such an injury a serious problem?
Some types of facial skeleton fractures are relatively minor, while others can cause serious harm and even be life threatening. That is why it is important to conduct the correct diagnosis and treatment before serious complications can occur.
The facial nerves and muscles responsible for sensations, facial expressions and eye movements are located near the bones of the face. In close proximity is the brain and central nervous system (CNS). Fractures of the facial bones can damage the cranial nerves, depending on the specific type and location of the fracture. Fractures of the orbital bone (orbit) can lead to vision problems. Fractures of the nose can make breathing or smell difficult. In addition, jaw bone fractures can cause breathing problems or make eating and speech difficult.
If an injury to the facial bones occurs, the victim should immediately seek medical help.
Types of Fractures
There are several main types of fractures of the facial bones of the skull. They are classified for various reasons, in particular according to their localization. For bone fractures of the facial skeleton, ICD 10 includes rubrics that determine the nature of the damage depending on the type of injury: it can be closed, open or of an indefinite type.
According to the severity, fractures of the facial bones are divided into 4 groups:
- with a fracture of the first degree, the skin is damaged by a fragment from the inside;
- with a fracture of the second degree, the presence of a superficial wound of the skin and soft tissues, a slight clogging of the wound;
- with a third degree fracture, massive soft tissue injuries are observed that can accompany injuries of the great vessels and peripheral nerves;
- with a fourth degree fracture, subtotal or total amputation of segments is noted.
Fractures of the nasal bone
This type is the most common. The nasal bone consists of two thin bones. In order to break the nasal bones, less effort is required than with the fracture of other bones, since they are quite thin. With a fracture, the nose, as a rule, looks deformed, pain appears. Edema can make damage assessment difficult. Epistaxis and bruising around the nose are common symptoms of this trauma.
Frontal Fractures
The frontal bone is the main bone in the forehead. Fracture is most often found in the middle of the forehead. It is there that the bones are the thinnest and weakest. Damage can cause the bone to be pressed inward. In order to break the frontal bone, significant force is required, therefore, often this injury can be accompanied by other injuries to the face, skull or neurological damage. This can cause cerebrospinal fluid (cerebrospinal fluid outflow), eye injuries and damage to the nasal canal.
Zygomatic bone fractures
The cheekbones are attached at several points to the upper jaw and the bones of the skull. With their fractures, injuries to nearby bones are also possible, in particular, damage to the sinuses of the upper jaw. As a result of an injury, the zygomatic bone, zygomatic meadows, or both can break.
According to patients themselves, such fractures often cause facial asymmetry. Fractures of the zygomatic bone make up the majority of fractures of the maxillofacial bones.
Orbital fractures
There are three main types of such injuries:
- Fracture of the orbital rim (outer edge), the thickest part of the orbit. It will take a lot of strength to break this bone. Such a fracture may be accompanied by damage to the optic nerve.
- Fracture of the rim extending to the lower edge and bottom of the orbit. In this case, a fracture of the facial bone under the eye is observed.
- Fracture of the thinnest, lower part of the orbit. In this case, the orbital rim remains intact. Eye muscles and other structures can be injured. With such an injury, the mobility of the eyeball may be limited.
Midface Fractures
With blunt injuries, fractures often occur along three lines passing along the joints of the bones, in the thinnest and weakest places, as well as where physiological holes are located. According to the classification of Le Fort, there are three main types of fractures, but their variations can also be found:
- Fracture of Le Fort I. With such an injury, the zygomatic bone and upper jaw break, they are completely disconnected from other bones of the skull. Often accompanied by a fracture of the base of the skull.
- Fracture Le Fort II. The fault line runs from the bottom of one cheek, under the eye, through the nose and to the bottom of the other cheek.
- Fracture of Le Fort III. In this case, the alveolar bone breaks off . The fault line passes through the nasal fundus and maxillary sinuses. With such an injury, the maxillary nerve node is damaged.
Lower jaw injuries
With fractures of the lower jaw, the angle of the lower jaw, the condylar and articular processes, and the chin are most often damaged. By localization, fractures of the body and branches of the lower jaw are distinguished.
Causes
Fractures of facial bones occur for a variety of reasons:
- traffic accidents;
- sports injuries;
- accidents, including in the workplace;
- falling from a height;
- falls from a standing or moving vehicle;
- mutilations caused by any object or another person;
- gunshot wounds.
Symptomatology
With any fracture, pain, bruising and swelling appear. Most of the symptoms depend on the location of the fracture.
With a fracture of the lower jaw are observed:
- profuse salivation;
- trouble swallowing;
- malocclusion;
- discoloration of the skin;
- jaw displacement.
With a fracture of the upper jaw, the following are possible:
- nose bleed;
- swelling under the eyes and eyelids;
- stretching the face.
Symptoms of a nasal fracture may include:
- discoloration under the eyes;
- blockage of one or both nostrils or displacement of the septum;
- curvature of the nose.
Symptoms of an orbital fracture:
- blurred, impaired or double vision (diplopia);
- difficulty moving your eyes left, right, up, or down;
- swollen forehead or cheek or swelling under the eyes;
- sunken or bulging eyeballs;
- redness of the eye proteins.
First aid
Before the victim will be sent to the doctor, he must provide first aid. Cold should be put in place of injury. It is impossible to correct displaced fragments of bones independently. In this case, you can apply a bandage and deliver the victim to a medical facility.
Diagnostics
First of all, the presence of any life-threatening injuries is determined. The doctor should check if anything is blocking the airways or nasal passages, assess the size and reaction of the pupil, and determine if there is any damage to the central nervous system.
The doctor then finds out how and when the injury occurred. The patient or his representative must provide information on whether there are any other medical problems, for example, chronic diseases, previous facial injuries or operations. After this, a physical examination of the face is carried out for signs of asymmetry and damage to motor functions.
A CT scan may be required for diagnosis.
When a nose fracture occurs, an x-ray may not be necessary if the edema is limited by the bridge of the nose, the patient can breathe through each nostril, the nose is straight, and there is no blood clot on the septum. Otherwise, radiography is performed.
Your doctor may also send you for computed tomography (CT) scan to determine the exact location and type of fracture or fractures.
Treatment
The type of treatment will depend on the location and extent of the damage. The goal of the treatment of facial fractures is to restore the normal appearance and function of the affected areas.
A fracture of the face can heal without the intervention of a doctor if the broken bone remains in a normal position. Severe fractures usually have to be treated. Therapeutic procedures include the following.
The doctor puts the broken bones in a normal position without making any incisions. As a rule, this method is used for fracture of the nose.
Endoscopy: with the help of an endoscope (a long tube with a camera and a bulb) placed inside through a small incision, the doctor examines the damage from the inside. During endoscopy, small fragments of broken bones can be removed.
Medicines:
- decongestants that help reduce swelling in the nose and sinuses;
- painkillers;
- steroidal anti-inflammatory drugs to reduce swelling;
- antibiotics in case of risk of infection.
Orthodontic treatment is carried out with damaged or broken teeth.
Surgical intervention: the doctor uses a wire, screws or plates to connect the broken bones of the face.
Reconstructive surgery may be required to correct parts of the face that are deformed by trauma. Sometimes it is necessary to remove parts of broken bones of the face and replace them with transplants.
Rehabilitation
After surgery, the patient is in the hospital for at least ten days. The timing of recovery is influenced by such factors as the time of seeking help from the moment of injury, the place and nature of the fracture. Complete recovery after a fracture of the bones of the facial skeleton occurs on average a month later. During this period, increased loads should be excluded, the patient is prescribed a calcified diet. After recovery, the patient, as prescribed by the doctor, may take vasoconstrictor nasal preparations for some time.
The risks
Facial fracture treatment can lead to swelling, pain, bruising, bleeding, and infection. After surgery, scars may remain. During treatment, nearby tissue and nerves can be damaged, resulting in numbness. During the operation, the sinuses may be damaged. Even with surgical intervention, it is possible to maintain the asymmetry of the face, changes in vision. Bone and tissue grafts can budge, and then another operation is required. The plates and screws used to fix the bones may become a source of infection or need to be replaced. There is also a risk of blood clots.
The consequences of fractures of the facial bone without treatment may be asymmetry of the face, pain in the face, eyes or blindness. Bleeding can block the airways, making breathing difficult. Cerebral hemorrhage is also possible, which can lead to convulsions and be life threatening.
Preventive measures
It is not possible to completely prevent fractures of the facial bones. However, there are a number of measures that can reduce the degree of injury:
- wearing a helmet while riding a bicycle or motorcycle;
- use of a seat belt in the car;
- use of protective equipment (helmets, masks) during sports activities;
- compliance with safety regulations during work.