Facial Fracture Care and Repair

Orbital Fractures

When one or more bones are broken in the eye socket it is called an orbital fracture. Sometimes it is called a blow-out fracture when the fracture occurs in the floor (lower part) of the orbit. It may involve the orbit and the cheek bone or extend from the orbit into the bones inside the nose under the orbit. These fractures can occur from falls, car crashes, sports accidents, assaults, and other forms of trauma to the face or head.

Symptoms

• Bruising or swelling around the eye

• Changes in feeling

• A “sunken eye”

• Changes in vision such as double vision

• Decreased movement of the eye

How It Is Diagnosed

These fractures are found on physical exam, x-rays, or CT scans.

Treatment

Treatment depends on where the fracture is and how severe it is. In some cases, orbital fractures may need to be repaired in surgery. The surgeon may wait until swelling and bruising decreases.

To reduce bleeding and swelling after trauma or surgery, use cold wet packs for the first 36 to 48 hours. Then sleep with the head elevated.

Broken Nose or Nasal Fracture

A nasal fracture or broken nose is the most common type of facial fracture. It occurs when there is a crack or break in one of the two bones over the bridge of the nose. A more severe fracture may extend into the orbit of the eye or inside the nose beneath the orbit. These fractures can occur from falls, sports accidents, assaults, car crashes and other forms of trauma to the face or head.

Symptoms

• Pain

• Bruising

• Swelling or misshapen nose

• Bloody nose or clear spinal fluid drainage

• Bruising and swelling of the eyes

• Trouble breathing through the nose

How It Is Diagnosed

A broken nose is found by physical exam or an x-ray.

Treatment

Treatment depends on where the fracture is and how severe it is. In many cases no surgery is needed.

Apply ice or cold packs to the injured area of your nose for 15 - 20 minutes each hour while awake to reduce swelling. Apply ice or cold packs at least 3-4 times a day for 2 days. Place the ice in a small plastic bag with a towel between the ice and your skin. Raise the head of the bed to decrease bleeding and swelling. Sometimes the doctor will place soft gauze in the nose (nasal packing) to stop bleeding.

If the nose is not in line, the doctor may straighten it by hand. If you need surgery, the plastic surgeon may wait until swelling and bruising decrease.

Jaw Fractures

A fractured jaw occurs when one or more bones are broken in the upper jaw (maxilla) or lower jaw (mandible). Fractures that involve the jaw are named Le Fort fractures and can be type I, II, or III depending on the bones affected. These fractures can occur from falls, car crashes, sports accidents, assaults, and other forms of trauma to the face or head.

Symptoms

• Bruising

• Swelling

• Pain and tenderness over the fracture site

• Numbness

• Cuts

• Bleeding

• Facial deformity

• Malocclusion (the feeling that your teeth don’t bite together like they should), misaligned teeth, and lost or loosened teeth

How It Is Diagnosed

A broken jaw is found by physical exam or with an x-ray. Sometimes the fracture is seen on a CT scan of the head, which was done for other reasons.

Treatment

Treatment depends on where the fracture is and how severe it is. In some cases you will have maxillo-mandibular fixation (MMF) for 1-8 weeks. This is when the jaws are lined up and arch bars (like braces) are put in place and wired or rubber banded to keep your jaws shut. This allows the break to heal in a correct manner.

Open reduction and internal fixation (ORIF) surgery may be needed for certain types of fractures and more severe fractures.

Apply ice or cold packs to the injured area of your jaw 15 - 20 minutes each hour while awake to reduce swelling. Apply ice or cold packs at least 3-4 times a day for 2 days after injury or surgery. Place the ice in a small plastic bag with a towel between the ice and your skin. Raise the head of the bed to decrease bleeding and swelling. If you need surgery, the surgeon may wait until swelling and bruising decrease before operating.

Cleaning Teeth and Mouth

Use a children’s toothbrush, rinsed in warm water to soften with toothpaste to brush your teeth each morning, before bed, and after meals. The children’s toothbrush works better than a soft toothbrush to remove bacteria, blood, mucus and other matter that can cause infection or tooth decay. Toothettes (mouth cleaning sponges) do not clean the bacteria and debris from teeth to prevent infection or decay after MMF or surgery of the mouth.

Rinse your mouth with saline (salt water) or a prescribed mouth wash after injury, MMF, or ORIF.

Eating

Once you are cleared to drink, only drink clear liquids. Next, your diet will be advanced to full liquids, then you will proceed to a pureed diet. This diet includes blended foods that you thin with a little water or milk so that you can drink the food. The nutritionist will explain this diet and tell you how to make safe food.

Cheekbone (Zygomatic) Facial Fractures

A zygomatic fracture is a fracture of the cheekbone caused by a direct blow to the cheek. These fractures can occur from sports accidents, assaults, falls, car crashes, and other forms of trauma to the cheekbone.

Symptoms

• Bruising

• Swelling

• Pain and tenderness over the fracture site

• Numbness

• Cuts

• Bleeding

• Facial deformity

• There may also be symptoms of orbital fracture(s)

How It Is Diagnosed

A broken cheekbone is found by physical exam or with an x-ray.

Treatment

Treatment depends on the where the fracture is and how severe it is. In some cases, no surgery is needed.

Apply ice or cold packs to the injured area 15-20 minutes each hour while awake to reduce swelling. Apply ice or cold packs at least 3-4 times a day for 2 days. Place the ice in a small plastic bag with a towel between the ice and your skin. Raise the head of the bed to decrease swelling.

Other fractures may need surgery to repair. The surgeon may wait until swelling and bruising have improved.

When to Call

• Trouble breathing or choking.

• Increased pain at the injury or surgical site.

• A change in vision.

• Numbness or tingling at the injury or surgical site.

Who to Call

University Hospital ENT Clinic

608-263-6190

After hours, weekends, and holidays the clinic number will be sent to a paging operator. Ask for the ENT doctor on call. Give your name and phone number with area code. The doctor will call you back.

The toll-free number is 1-800-323-8942.