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Facial Trauma

Facial injuries, also called maxillofacial injuries, is any physical trauma to the face. Facial bones such as the lower jaw ( mandible ) , midface (maxilla), cheekbones, eye sockets , nose, palate and skull bones may crack and fracture as a result of high velocity trauma such as motor vehicle accidents and sports injuries or low velocity trauma from falls and assaults. Often these bony injuries are associated with dental injuries such as avulsed or fractured teeth and soft tissue lacerations. Symptoms are specific to the type of injury; for example, fractures may involve pain, swelling, loss of function, or changes in the shape of facial structures. Facial injuries have the potential to cause disfigurement and loss of function; for example, blindness or difficulty in moving the jaw can result. Although it is seldom life-threatening, facial trauma can also be deadly, because it can cause severe bleeding or interference with the airway; thus a primary concern in treatment is ensuring that the airway is open. Treatment may also be necessary for other injuries such as head injury which commonly accompany severe facial trauma.

Maxillofacial Surgery is a surgical super specialty which involves the diagnosis, surgery and management of diseases, injuries and defects involving both the functional and aesthetic aspects of the maxillofacial region. This training focuses almost completely on the bone, skin and muscle of the face, mouth and jaw. Plastic surgeons have knowledge and expertise that uniquely qualifies them to diagnose and treat a number of functional and aesthetic conditions in this anatomical area. They are experts in treating and repairing facial injury and trauma, including facial fractures and facial lacerations. Their knowledge of how jaws come together (dental occlusion) is critical when repairing complex facial fractures. If you or a loved one sustained a facial injury that requires a trip to the emergency room, be sure to ask that a plastic and maxillofacial surgeon called for consultation. With their background and training, plastic and maxillofacial surgeons are some of the highest qualified personnel to treat facial trauma. In some cases of facial trauma, bone and/or skin loss may result. Plastic Surgeons are well equipped to address many of these deficits with various means of hard and soft tissue grafting. Their understanding of both form and function of the maxillofacial skeleton and soft tissue is what sets them apart from any other surgical specialty. In some cases, they may even detect a “hidden” injury that might otherwise go unnoticed. The best reconstructive results are achieved by Doctors with intimate knowledge and understanding of head and neck anatomy, aesthetic facial surgery, functional oral surgery and the concepts of occlusion. Plastic and Maxillo-Facial Surgeons are the best trained surgeons in this discipline. Dr Goyal has vast experience of comprehensive management of more than 2000 cases of extended spectrum head-neck-face trauma including orbit and soft tissue injuries.'
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.

Before surgery
Often a 3D CT scan of the face will be required to assess the degree of damage and to plan the reconstruction. Sometimes operative treatment is delayed for a number of days to allow the facial swelling to settle.

Surgery
The surgery will be performed through small and concealed keyhole incision or through incisions inside the mouth. The dentition is used a centre stone for the reconstruction with the upper and lower teeth set in the correct occlusion ( bite ) to rebuild and reconstruct the surrounding bones by open reduction and internal fixation of fractures utilizing titanium mini plates and screws. Broken teeth may need to be repaired by a dentist after bony healing has occurred or may need to be replaced later by titanium implants. Most fractures and soft tissue injuries will be repaired under a general anaesthesia in hospital. A plastic surgeon does not heal broken bones as body does it itself. He brings them to correct alignment and stabilize them there with micro plates and screws. The most important thing is that how he approaches to the fracture sites. He cannot afford to cut right on top of the fracture site and get in to fix it, as it would leave the face with a nasty scar. An experienced plastic surgeon attempts at accessing the facial bones through the fewest incisions necessary. At the same time, the incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is hidden.

After surgery
Post operatively patients are prescribed antibiotics and pain killers as well as an antibacterial mouthwash. It is important for patients to adhere to a liquid diet for six weeks following fracture repair of the lower jaw and mid face. It is important after all soft and hard tissue reconstruction to abstain from contact sports for a minimum of six weeks. It is important to keep the wounds as clean as possible to ensure the best chance of optimal healing. Skin sutures (stitches) are ideally removed day 5-7 post operatively. Intra oral sutures will dissolve by themselves within 2 weeks. Sometimes it is necessary to wire the teeth together or hold the teeth together with elastic bands attached to arch bars or inter maxillary fixation screws for a period of 6 weeks. This is particularly the case highly comminuted facial fractures. In these cases a blended liquid diet will be required and all food will need to be processed and put through a juicer or blender to make it soft in consistency. In such cases oral hygiene will be more challenging.
The titanium plates and screws are inert and very bio compatible and usually do not need to be removed. Usually these injuries heal very predictably and patients can resume all normal activities and get back to normal life.
Poor healing is extremely rare if patients adhere to post operative advice and instructions. The proper treatment of facial injuries is now the realm of plastic surgeons who are well versed in emergency care, acute treatment, long-term reconstruction, and rehabilitation of the patient. Excellent healing and a fast return to normal form and function is the norm.