A maxillofacial fracture is a break in any of the 14 bones that form the structure of the face. These injuries range from a simple crack in a single bone to complex breaks involving multiple bones. Such fractures can affect a person’s ability to breathe, eat, and see, and may alter their facial appearance. Addressing these injuries properly is important for restoring function and form.
Types and Causes of Facial Fractures
The mandible, or lower jaw, is a common site for fractures resulting from direct impact. Breaks in the maxilla, or upper jaw, are more complex and are categorized using the Le Fort classification system. A Le Fort I fracture involves a horizontal break separating the upper jaw from the rest of the face. A Le Fort II fracture is pyramidal, involving the nasal bones and eye sockets, while a Le Fort III fracture is the most severe, causing a complete separation of the facial bones from the skull.
Other common facial fractures include the orbit (the bones surrounding the eye). A specific type known as a “blowout” fracture occurs when the thin floor or inner wall of the eye socket breaks. The zygomatic bones, or cheekbones, can also fracture, sometimes leading to a flattened appearance of the face. Nasal fractures, or broken noses, are among the most frequent types of facial fractures due to the nose’s prominent position.
Common causes of these injuries include:
- Motor vehicle collisions
- Physical assaults
- Accidental falls
- Contact sports such as football, boxing, and rugby
Signs and Diagnosis
Pain at the site of impact is a primary symptom, often accompanied by significant swelling and bruising. Fractures involving the eye socket may cause “raccoon eyes,” or periorbital ecchymosis. Difficulty opening the mouth, chewing, or speaking can indicate a jaw fracture. A common sign is malocclusion, where the teeth no longer fit together correctly.
Facial numbness is another indicator, often resulting from nerve damage associated with the fracture. Vision problems, such as double vision (diplopia) or blurry vision, can occur with orbital fractures. These symptoms signal the need for a thorough medical evaluation to determine the extent of the injury.
Diagnosis begins with a physical examination, where a doctor will check for pain, swelling, and abnormal movement of the facial bones. They will also assess nerve function and vision. Following the physical exam, imaging studies are used to confirm the diagnosis and visualize the break. While X-rays can identify simpler fractures, computed tomography (CT) scans are considered the standard for evaluating complex facial injuries because they provide detailed images, allowing surgeons to plan treatment accurately.
Treatment Approaches
For stable fractures where the bone fragments have not moved out of place, non-surgical management may be sufficient. This can involve pain management. In some cases, a technique called maxillomandibular fixation (MMF) may be used, which wires the jaws together to immobilize the fracture, similar to a cast on a broken limb.
Severe or displaced fractures require surgical intervention. The most common procedure is Open Reduction and Internal Fixation (ORIF). During ORIF, the surgeon makes an incision, often through the mouth or along natural skin creases to minimize visible scarring.
The surgeon then carefully realigns the broken bone fragments into their proper anatomical position, a step known as reduction. Once the bones are correctly aligned, they are held in place with small, medical-grade titanium plates and screws. This internal fixation provides stability, allowing the bones to heal correctly, and the plates and screws are typically left in place permanently. The surgery is performed by specialists like oral and maxillofacial surgeons or plastic surgeons.
The Recovery Journey
Applying ice packs to the affected area can help reduce swelling, and pain medication is prescribed as needed. Chewing may be restricted to protect the healing bones, so patients are often placed on a liquid or soft food diet for several weeks.
Bone healing takes about six to eight weeks for the bones to knit together. However, full functional recovery, including the return of normal sensation and muscle function, can take several months. The titanium hardware used in surgery integrates with the bone and does not cause long-term issues. Patients are advised to avoid activities that could result in another facial injury during this time.
Patients will have several appointments with their surgeon to monitor healing. These visits allow the medical team to check that the bones are setting correctly and to identify any potential complications, such as infection or problems with the fixation hardware. Adhering to the follow-up schedule ensures the best possible outcome for both function and appearance.