Facial trauma: what to do when it occurs

Facial trauma occurs in the form of a fracture when an impact acts on the bone and the bone cannot absorb it. The most common causes are traffic accidents or aggressions. It is very important to know how to treat them to ensure vital functions and repair the fracture.

Facial trauma is a damage suffered by bone tissue, soft tissue, as well as existing facial organs and cavities, in the face of an impact (force, energy), absorbing it. The facial skeleton is able to tolerate (absorb) this energy up to a certain point, according to experts in Oral and Maxillofacial Surgery. When this energy exceeds the absorption capacity, a consequence called fracture occurs.

The impact acts on the bone by compression, traction, crushing and rotation. In addition, facial trauma has a very important muscular component in relation to fragment deviation.

Facial trauma accounts for 30% of polytraumatized patients, with a prevalence of 3/1 between men and women.

The most frequent causes of facial trauma are:
– Traffic (60%)
– Assaults (30%)
– Sports (5%)
– Occupational (3%)
– Other (2%)

Facial bone architecture
Facial architecture is composed of:
1. Resistant structures that reinforce the bony framework, called Arbors:
(a) Verticals / Pillars: they function by transmitting their forces upward, and succumb to transverse or oblique direction impacts. They resist vertical impacts well.

b) Horizontal / Beams: They are structures that protect against anteroposterior impacts. They are located at the level of the frontal bone, at the level of the orbitomalar area and at the maxillary level.

2. Fragile structures. These are areas of union of different bones or different parts of the bone. For example, the jaw: condyle, angle, mentonian foramen.

The facial skeleton is also attributed with structures called bumpers:
– At the anterior level: frontal bone, nasal bone and chin.
– At the lateral level: orbito-malar complex.

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On the other hand, if we were to look at facial trauma by bony units, we would see that the mandibular bone would be divided into:
– Symphyseal/ parasymphyseal area (7)
– Mandibular body (6)
– Mandibular angle (4)
– Ascending branch (3)
– Coronoid (1)
– Condyle (2)

The facial mass is comprised of:
– Frontal bone (1)
– Nasal (5)
– Orbital (2)
– Zygomatic-malar (3)
– Upper jaw (4)

Symptoms of facial trauma
A facial fracture will be suspected whenever trauma has occurred or when clinical signs are observed, such as: bone deformity, facial asymmetry, subsidence, abnormal mobility, hematoma, edema, swelling, pain on palpation and/or mobility or functional limitation.

Treatment of facial trauma
Treatment consists of three procedures:
1. ensure Vital Functions:
– Airway patency
– Control of hemorrhage
– Circulatory stabilization
– Neurological assessment and associated pathologies
2. Repair fracture sites:
– Reduction of the fracture site(s), placing the separated bone fragments in correct anatomical position.
– Absolute immobilization of the fracture: osteosynthesis plate.

3. Complementary pharmacology to avoid infections and to reduce inflammation and pain.

Recovery will depend on the type of injury suffered, depending on whether it is mild, moderate or severe. In general, its evolution is favorable, as long as the appropriate requirements are met. Nowadays, recovery is relatively short and there are no complications and/or sequelae, avoiding long stays in the hospital.