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Facial Injuries

Synonyms: Facial Trauma, Face Injury

What are Facial Injuries?

Facial Injuries or Facial Trauma is injury to the bone or soft tissues of any part of the face including ears, eyes, tongue, lips and teeth. Facial Injuries can result from sharp edged or pointed objects, blunt objects, flying particles and objects, and gun shots.

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What are the common causes of Facial Injuries?

The most common causes of Facial Injuries include:

  • Sports or recreational activities, such as ice hockey, basketball, rugby, soccer, or martial arts.
  • Occupational (work related)
  • Motor vehicle accidents
  • House related projects
  • Falls
  • Fights e.g. gun shot, stabbing
  • Animal and human bites
  • Burns
  • Facial fractures
  • Facial Soft Tissue Trauma like injury to the scalp, eyebrows, eyelids, tear gland and duct, ear, salivary gland and duct, nose, lips and facial nerves

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What are the manifestations of Facial Injuries?

  • Bleeding
  • Bruising
  • Head injury
    • Loss of consciousness.
    • Loss of memory.
    • A severe headache, or a headache that continues to get worse.
    • Confusion, abnormal behavior, irritability.
    • Extreme sleepiness or difficulty waking up.
    • Slurred speech.
    • Numbness, weakness, or loss of movement in the arms or legs.
    • Vision changes and changes in the pupils' size, shape, and reaction to light.
    • Dizziness, vertigo, or unsteadiness that prevents standing or walking.
    • Persistent nausea and vomiting.
    • Seizure
  • Spinal Injury
    • Severe neck or back pain.
    • Paralysis
    • Weakness, tingling, or numbness in the arms or legs.
    • Loss of bowel or bladder control.
  • Difficulty talking, breathing or swallowing
  • Dislocated jaw
    • Misshapen face
    • Difficulty opening and closing your mouth.
  • Changes in sensation and feeling over the face
  • Eye injury
    • Swelling around the eyes may cause limitations in vision.
    • Partial or complete loss of vision
    • Floaters which may appear as dark specks, strings, or cobwebs that float through the eye.
    • Double vision
  • Missing teeth
  • Temporo-mandibular Sprain
  • Fracture of the facial bones such as:
  • Cut or puncture wound to your face or inside your mouth
  • Infection
    • A skin infection (cellulitis).
    • A pus-filled pocket (abscess) just under the skin surface or deep in tissue.
    • A bone infection (osteomyelitis).
    • A sinus infection (post-traumatic sinusitis).
    • An infection of the membranes covering the brain (meningitis)
  • Avulsion injury which is a cut or scrape that removes all the layers of the skin, exposing the fat or muscle.
  • Abrasions, contusions

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How are Facial Injuries treated?

Facial Injuries are treated in two phases; immediate treatment of Facial Injuries (acute phase) and delayed treatment of Facial Injuries (surgical intervention).

  • Immediate Treatment of Facial Injuries
    • Do not move damaged or broken facial bones - It may make an injury worse and increase bleeding.
    • Ensure patency of Airway - Establishing a patent airway is definitely a priority for the management of Facial Injuries.
    • Visual Examination and Palpation - Examine the face starting from the scalp down to the upper part of neck and side-to-side (from ear-to-ear). Examine for any obvious swellings, depressions, or bruising.
    • Stop the Bleeding - Face is a very vascular part of the body therefore, Facial Injuries have a tendency to bleed profusely. Apply steady pressure for 15 minutes at the site of injury. In case of a nosebleed, apply an ice pack to your nose and cheeks and keep pinching the soft part of your nose for 15 minutes.
    • Wound Decontamination and Debridement - This step consists of removing debris, pus, blood, glass or gravel from the wound. This is usually done with cleansing and irrigation with normal saline.
    • Wound Assessment - Assess if there is any damage or injury to blood vessels, nerves, tendons, ligaments, joints, bones, or internal organs.
    • Medications - Pain medication, antibiotics and a tetanus shot are the first line of treatment.
    • Diagnostic Studies - It is important to perform diagnostic tests like x-ray, CT scan, MRI and arteriography to plan appropriate management of complicated Facial Injuries.
    • Wound Exploration - After wound cleansing, using adequate anesthesia to numb the pain and discomfort. Undiscovered foreign bodies, partial tendon lacerations, and joint penetration are more likely to be overlooked if a wound is not adequately explored.
    • Wound Closure - Staple closure is not suitable for wounds from Facial Injuries. Minimal or non-tension sutures significantly impact the esthetic appearance of the wound and play an important role in the mechanism of closure. Observation of the lines of expression is vital to a natural-appearing repair. Wounds on the face may be closed up to 24 hours after injury.
    • Repair of Facial Injuries - Repair of Facial Injuries within the first 12 - 24 hours is optimum as the tissues are less prone to infection and and the healing would be faster.
    • Open or Closed Reduction of fracture of the facial bones.
  • Surgical Intervention for Facial Injuries
  • Assessment of loss of function due to Facial Injuries
    • Consultation by an ophthalmologist, E.N.T. specialist and a neurosurgeon is necessary for management of severe Facial Injuries.

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What is the 'rehab' like following Facial Injuries?

Facial Injuries can impart a high degree of emotional, as well as physical trauma. The art of managing these injuries requires team of specially trained health care professionals who will educate you and your family on how to provide best care during rehabilitation period, and will also outline specific problems that might require immediate medical attention. The team of health professionals for the management of Facial Injuries will comprise of neurosurgeon, cosmetic dentist, orthodontist, speech therapist, E.N.T. specialist, eye specialist, hearing specialist, psychiatrist and a social worker.

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B . R . A . N . D . of repair of Facial Injuries

Benefits of repair of Facial Injuries

  • With the availability of state-of-art computer imaging system, you will have a better idea of the results that might be achieved by surgical intervention. A formal treatment plan will be put together utilizing the skills and expertise of health care professionals specializing in management of Facial Injuries. Corrective treatments for Facial Injuries will most definitely improve the esthetics of your face, it will also improve breathing and feeding problems that are associated with Facial Injuries.

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Risks of repair of Facial Injuries

Like all other Cosmetic & Plastic Surgery procedures, corrective treatments for Facial Injuries involves the risk of complications including:

  • Asymmetry of your face - This a common problem when one side of your mouth and nose do not match the other side. In such a case, a revision surgery is performed to try and match both the sides of the face as closely as possible.
  • Incomplete repair of Facial Injuries - A second operation or revision surgery may be required for complete correction.
  • Infection of the incision site
  • Allergic reaction to anesthesia
  • Bleeding, swelling, bruising and delayed healing - It is normal to have some bruising and oozing of bloody discharge from the face areas which will soon subside.

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Alternatives to repair of Facial Injuries

  • The treatment options discussed above are the best available for individuals with Facial Injuries.

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Now or Never

  • Facial Injuries can range from mild abnormalities to extensive deformities involving the entire face and skull. Sophisticated reconstructive surgical techniques yield tremendously gratifying and outstanding aesthetic and functional results.

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Decision to repair Facial Injuries

  • Each individual's needs are unique for corrective treatments for Facial Injuries and the treatment plans are customized to meet all of your physical and emotional needs i.e. from special dietary or language requirements, to educational or emotional considerations.

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Keywords: Fracture of Mandible, Maxillary Fracture, Jaw Fracture, Jaw Dislocation, Nasal Fracture, Broken Cheekbone, Motor Vehicular Accident, Falls, Assaults, Fights, Sports Injuries, Gunshot Wounds, Work Related Injuries, Occupational Injuries, Types of Face Fractures, Temporo-Mandibular Joint (TMJ), CT Scan, MRI, Muscles of Chewing, Cellulitis, Meningitis, Post-Traumatic Sinusitis, Osteomyelitis, Open & Closed Reduction of Fracture, Eye Injury

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