Facial Trauma

Facial Trauma

Dr. Abel received his oral & maxillofacial surgery training at the Hospital of the University of Pennsylvania, a Level 1 trauma center. Now in private practice, Dr. Abel can evaluate and treat certain facial injuries to the mouth and jaws. These include:

  • Avulsed (knocked out) or displaced teeth
  • Simple fractures to the upper and lower jaws
  • Certain lacerations of the soft tissue structures in the mouth

There are a number of common causes of facial trauma such as motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. The 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 to the mouth and face

When soft tissue injuries such as lacerations occur in the mouth or on the face, they are typically repaired by suturing. A proper repair of a soft tissue laceration would include evaluation of the injury for damage to underlying nerves, blood vessels, or salivary ducts, as well as the performance of a cosmetic closure of the wound. Sometimes, even with the best repair, injury to underlying structures or the prevention of facial scarring is unavoidable. In most cases, Dr. Abel will refer the repair of complicated facial lacerations to an ENT physician or plastic surgeon, for this reason. If the soft tissue injury is isolated within the mouth, Dr. Abel can evaluate the wound and perform a definitive repair, unless there has been significant damage to underlying structures that are best repaired by an ENT physician.

Bone injuries to the jaws or face

Fractures (breaks) to the bones of the face are treated in a manner similar to fractures of bones 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 of the patient, and the patient’s general health.  When an arm or 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.

The most common method for treatment of fractures to the upper or lower jaws involves wiring the teeth and jaws together. This serves the purpose of stabilizing the jaw bones to allow for healing. This jaw fixation can be augmented by the placement of metal plates and screws onto the bone, a technique called “open reduction internal fixation.” Although placement of plates and screws involves further surgery, the rigid fixation that it provides sometimes reduces the time needed for the teeth and jaws to be wired together.

Fractures may occur to other bones of the facial skeleton, including the nose, orbits (eyes), or zygomas (cheek bones). While Dr. Abel does not regularly treat fractures to these bones of the face, he can refer you to an ENT physician or plastic surgeon for repair, when indicated.

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 & maxillofacial 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 several forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be kept moist inside the lower lip or placed into a glass of milk or salt water. 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 & maxillofacial surgeon as soon as possible. Never attempt to wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists, such as endodontists, may be called upon to perform root canal therapy; or restorative dentists may be required to repair or rebuild fractured teeth. If the injured teeth cannot be saved or repaired, dental implants are often utilized as replacements for missing teeth.

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.