Face and Neck Trauma

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Face And Neck Injuries

What are the most common injuries of the facial skeleton?

The occurrence of facial injury or trauma has declined markedly since the advent of safety belts and air bags in modern vehicles. Nowadays, many of the less extensive but more common fractures of the nose and cheek bone occur as a result of sports accidents. Still, the more major injuries are associated with vehicle accidents or violence.

How can the surgeon tell whether some part of the facial skeleton has been fractured and what treatment is required?

The facial skeleton can be divided into 3 sections: the forehead, the middle face and the mandible or jaw.

The Forehead

Fractures involving the forehead may be single, linear ones with no bone displacement. A fracture is a break or crack in the bone that has been caused by physical trauma. It can, but does not necessarily involve, movement and displacement of the bone(s). Even if the bony damage is minimal, a fracture can still be associated with symptoms that range from those of a minor concussion to coma.

When the fracture line crosses the middle part of the forehead, the underlying frontal sinus may be damaged. In this portion of the skull, the bone contains some lined air cavities or pockets called the frontal sinuses that drain into the nose. These frontal sinuses have an outer and an inner wall. (See diagram A) When only the outer wall is fractured with displacement, obstruction of the drainage system of the sinuses and potential cosmetic deformity may occur and require surgical correction. A more severe injury can involve a facture of both walls, in which case surgery would, most likely, be required.

The Middle Face

The two most common locations for fractures of the middle face are the nose and the malar bone (cheek bone). Individuals with one or both of these fractures will have, among other symptoms, facial swelling and nasal bleeding.

Nasal fractures can involve either part or all of the nose. Nasal airway obstruction or blockage may be present and can be annoying. Unless other facial fractures are suspected, radiological studies (x-rays) are not required. Surgery is often postponed until the swelling is reduced and the surgeon can evaluate the extent of any cosmetic deformity likely to remain. Sometimes, bleeding within the middle wall of the nose (septum) can result in a haematoma (bruise), a collection of blood that requires drainage.

Usually, fractures of the cheek bone (malar bone) occur on one side only. In some situations, the individual may experience double vision. They should avoid blowing their nose because air is likely to penetrate underneath the skin and the orbit (eye socket) causing even more swelling. A CT-scan is often requested to complete the evaluation of the injury. Surgical repair of the fractures is often required if the floor of the orbit is significantly damaged, if there is reason to believe that the double vision will remain or if cosmetic deformity is expected.

More complex fractures of the middle section of the face happen with severe trauma and injury. The “Lefort” classification system is used to describe them. Individuals may have all of the previous symptoms as well as notice a “mismatch” between their upper and lower teeth. The treatment is usually more complex and may include having to fix the
bones with the overlying cranium and /or the underlying mandible (jaw).

The Mandible (Jaw)

An individual with one or more fractures of the jaw is often incapacitated. Talking and chewing movements are likely to cause a lot of discomfort. Sometimes, as with the fractures of the middle third of the face, teeth may be missing. This is a source of concern for both the surgeon and the individual involved. In most cases, repair of the fracture(s) is required using metallic plates, and/or wiring between the upper and lower teeth. Major damage of the mandible, like that caused by gunshots, may require an emergency tracheotomy (insertion of a breathing tube) to maintain a proper airway.

The Neck

Are neck injuries very dangerous?

Yes, they are. There are major structures located in the neck that can be easily damaged by a blunt or penetrating injury.

Tell me more about the risks.

The larynx (voice box) and the trachea (wind pipe) are important parts of the airway. Any crushing or penetrating injury can compromise breathing. Sometimes an emergency tracheotomy is necessary to save the person’s life. Major blood vessels, such as the carotid arteries and jugular veins, will bleed profusely if cut. This can rapidly become a life-threatening situation. The vertebral spine, if damaged, may need immobilization because of the risks of paralysis.

After an initial evaluation to rule out spinal injury, the neck will be inspected for any latent condition(s) that might require surgical intervention.