Facial
and Jaw Reconstruction
There are a number of possible causes of facial trauma.
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 bones of
the face. Typically, facial injuries are classified
as either soft tissue injuries (skin and gums), bony
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 such as lacerations occur
on the face, they are repaired by "suturing".
In addition to the obvious concern of providing a repair
which yields the best cosmetic result possible, care
is taken to inspect for 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 which include the location of the fracture,
the severity of the fracture, 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 certain fractures of the upper and/or lower jaw.
Certain other types of fractures of the jaw are best
treated and stabilized by the surgical placement of
small "plates and screws" at the involved
site. This technique of treatment can often allow for
healing and obviates the necessity 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,
allowing them to return to normal function more quickly.
The treatment of facial fractures should be accomplished
in a thorough and predictable manner. More importantly,
the patient's facial appearance should be minimally
affected. 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 and Surrounding Dental
Structures
Isolated injuries to teeth are quite common and may
require the expertise of various dental specialists.
Oral surgeons usually are involved in treating fractures
in the supporting bone or in replanting teeth which
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. Therefore,
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 which 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 now 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.
