Oral and maxillofacial surgeons are trained, skilled, and uniquely qualified to manage and treat facial trauma. Oral and maxillofacial surgery specialists must be well-versed in emergency care, acute treatment, and long-term reconstruction and rehabilitation of facial trauma, not just for physical reasons but for emotional reasons as well. Injuries to the face impart a high degree of emotional and physical trauma to patient. The science and art of treating these injuries requires special training involving hands-on experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.
The following conditions are often handled by an oral and maxillofacial surgeon:
- Facial lacerations
- Intraoral lacerations
- Avulsed (knocked out) teeth
- Fractured facial bones (cheek, nose or eye socket)
- Fractured jaws (upper and lower jaw)
The Nature Of Maxillofacial Trauma
There are a number of possible causes of facial trauma, such as motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bone of the face. Typically, facial injuries are classified as either 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 Of The Maxillofacial Region
When soft tissue injuries like lacerations occur on the face, they are repaired by suturing. In addition to providing a repair that will yield the best cosmetic result possible, care is also taken to inspect and treat injuries to structures such as facial nerves, salivary glands, and salivary ducts (or outflow channels).
Bone Injuries Of The Maxillofacial Region
Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, including the location of the fracture, the severity of the fracture, and the age and general health of the patient. When an arm or a 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.
One of these options involves wiring the jaws together for some fractures of the upper and/or lower jaw. Other types of jaw fractures may be best treated and stabilized by the surgical placement of small plates and screws at the involved site. This type of treatment can often allow for healing while eliminating the need of having the jaws wired together. This technique is called “rigid fixation” of a fracture. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many patients and allows them to return to normal function more quickly.
The treatment of facial fractures should be accomplished in a thorough and predictable manner that minimally affects the patient’s facial appearance. An attempt at accessing the facial bones through the fewest incisions necessary is always made. 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.
Injuries To The Teeth & Surrounding Dental Structures
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons are usually 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 a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive so the patient should see a dentist or oral 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 may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often utilized as replacements for missing teeth.