Facial or maxillofacial injury or trauma, describes any physical trauma to the face.  Oral and maxillofacial surgeons are specially trained to treat injuries to the face, jaws, mouth and teeth.

Facial trauma can involve soft tissue injuries such as burns, lacerations and bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, and trauma like eye injuries that can result in blindness.  Fractures may involve pain, swelling, loss of function like difficulty moving the jaw, or disfigurement of facial features.  Although facial trauma is seldom life-threatening, still it can be deadly, because it can cause severe bleeding or interference with the airway (a primary concern in treatment is to ensure that the airway is open and not threatened).

While motor vehicle accidents used to be the leading cause of facial trauma in developed countries, it is now in second place, probably due to safety measures such as seat belts and motorcycle helmets, and laws and enforcement to prevent drunk and unsafe driving.  Physical violence is now first; however auto accidents still come first in developing countries.  As many as 50–70% of people who survive traffic accidents have facial trauma.  Some other major causes of facial trauma include falls, industrial accidents, and sports injuries.

Like most other areas in medicine, trauma management has evolved significantly in the past few decades, reducing mortality in that first golden hour.  However, challenges remain, such as when there are severe injuries in the maxillofacial region in a patient who has other injuries in multiple body parts.  This can complicate the early management of a trauma patient because of the region’s proximity to the brain, cervical spine, and airway.  When there are maxillofacial injuries, the usual techniques of airway breathing and circulation (ABC) management are often modified or supplemented with other methods, with their own challenges and pitfalls in an already tenuous situation.

Commonly injured facial bones include the nasal bone, the maxilla (the bone that forms the upper jaw), and the mandible (the lower jaw), along with the zygoma (cheekbone) and the frontal bone (forehead).  Fractures may also occur in the bones of the palate and those that come together to form the eye socket. Although considered imprecise, facial fractures are still categorized in the Le Fort system:

  • Le Fort I — horizontal over the maxilla
  • Le Fort II — triangular including the maxilla, nasal bones, and eye socket floor
  • Le Fort III — horizontal mid-third of face, the most serious

With Le Fort fractures, the midface may move relative to the rest of the face or skull

Treatment may include the following, depending on the type of facial injury:

  • Bandaging and suturing of open wounds
  • Administration of ice
  • Administration of supplemental oxygen
  • Medication: antibiotics and pain killers
  • Tetanus vaccination
  • Moving bones back into place
  • Tracheal intubation (to assist breathing)
  • Surgery (fracture repair with metal plates and screws, wire, bone grafts)
  • X-rays or CT scans when fractures are suspected (for diagnosis)

In addition, treatment may be necessary for other injuries like traumatic head and brain injury, which commonly accompanies severe facial trauma.

Surgical specialists who commonly treat specific aspects of facial trauma are oral and maxillofacial surgeons. These surgeons are trained in the comprehensive management of trauma to the lower, middle and upper face.

If you are interested in treatment of facial injury in Costa Rica, fill out the “Find a Dentist” form on this page.  One of our patient advocates will reply to your needs.