Background

Facial fractures occur when the bones in the face including the skull or other facial bones are broken. These fractures can be caused by a variety of factors that involve significant force to the face. Fractures vary in severity and type based on the force applied and the bones involved. 

Causes 

Trauma: Car accidents and physical attacks often result in facial fractures. 

Workplace Injuries: Certain industries or work environments may have a higher risk of face injuries.  

Accidents: Everyday mishaps like slips and falls can also lead to facial fractures. 

Epidemiology

It often results from trauma and the most common causes include motor vehicle accidents–falls and occupational accidents. The incidence of facial fractures varies with age and gender. The incidence of facial fractures may vary across regions and populations. 

Anatomy

Pathophysiology

The face bones are constructed as a complex group of bones. Trauma may cause disruption at the sutures which connect one facial bone to another and the joints which are also called synarthroses connect faces bones. Dependent on the direction of the force– the nature of the crack modification originates.  When a stress is being applied during the injury– the energy is absorbed that is responsible for fractures in the bones of facial region. 

Etiology

The patient’s age has an impact on the etiology of face fractures. With 46.8% of occurrences in children under the age of nine and 40.7% in individuals over sixty where falls are the most common cause of face fractures. Car crashes are the leading cause of fractures of the face in young adults which accounts for 35.9% of occurrences in the 20 to 29 age range. 

Genetics

Prognostic Factors

Facial fractures present in a specific manner that may range from minor ones with a good prognosis to complex fractures with more complicated treatment. In addition– the prognosis is significantly impacted by the affected bones’ position inside the face and degree of involvement. Better results can be achieved with prompt medical rescue– on-site treatment– and effective fracture reduction. Though age can also affect the kind of fractures and treatment options– younger persons may recover more quickly than older ones. 

Clinical History

A simple fracture has a much better outcome compared to a complex one that involves more than one bone or severely displaced fragments. The bones hit and their locations in the face can change the way the prognosis is determined. Associated injuries like brain injuries, injuries to neck or other body parts can make the overall prognosis and treatment plans more difficult. 

Physical Examination

Look for any abnormalities such as edema or asymmetry in the general look of the face. 

Look for any indications of discolouration, hematoma or bruises. 

Check for open fractures- abrasions- or lacerations in soft tissues. 

Look for depressions and step-offs which might be signs of a fracture. 

Assess the patient’s head, mouth and jaw movement. 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Non-accidental trauma in the form of intimate partner violence– child abuse or neglect– or risk-taking behaviors can be used to diagnose facial fractures. A comprehensive physical examination is essential– particularly in youngsters whose traumatic event history may be incomplete. Exams for the musculoskeletal system and the skin should evaluate facial nerve palsy– damage– and the depth of wounds. Facial bone fractures are suggested by soft tissue edema and bony discomfort. 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Facial fractures are treated with a multidisciplinary strategy that takes both functional and cosmetic goals into account. The patient’s particular fractures structure, multiple conditions and surgical tolerance are taken into account while creating the plan. The ideal course of treatment for unilateral– minimally displaced fractures is closed therapy with guided elastic maxillomandibular fixation. Better results in terms of quality of life are obtained for more complex fractures with meticulous bone reductions along with open reduction and internal fixing. For the best results– endoscopic and transoral methods should be considered. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-a-non-pharmacological-approach-for-treating-facial-fractures

Elevation: Helps reduce swelling- particularly in fractures of the nose and eyes. 

Soft Diet: Helps mend mandibular fractures and prevents jaw strain. 

Oral hygiene: crucial for preventing infections- particularly in patients with dental trauma or fractures of the mouth. 

Speaking and Swallowing Therapy: When swallowing or speaking are affected by facial fractures- this therapy is advised. 

Physiotherapy is beneficial for certain face fractures- particularly those involving the temporomandibular joint. 

Role of NSAIDs in the treatment of Facial Fractures

Because they reduce inflammation and relieve pain- NSAIDs are essential in the treatment of facial fractures. They decrease the swelling in injured tissues by stopping the production of prostaglandins- which cause pain and inflammation. NSAIDs facilitate patients’ comfort and speedy return to normal activities. Often- they function in concert with non-pharmacological therapies, opioids and analgesics such as paracetamol as part of a multimodal strategy to assist patients in returning to their regular activities and reducing edema. 

Naproxen: It is often prescribed to help alleviate pain and swelling. It is typically recommended that adults take one tablet (220 mg) every 8 to 12 hours- with a maximum total daily dose of 660 mg. 

Role of Muscle Relaxants in the treatment of Facial Fractures

TMJ fractures are also the frequent problem which is being treated using muscle relaxants. One of their aims is to not only provide relief from pain but also to relax tense muscles as well as shorten the time one needs to recover. They can relieve pain by relaxing muscles and thereby easing tension and spasms- and this is of great use when such pain is worsened by muscles that are too tight. The mode of action of muscle relaxants consists in the reducing the frequency and the intensity of spasms, what is very significant during the acute rehabilitation phase. 

use-of-intervention-with-a-procedure-in-treating-facial-fractures

Usually carried out under regional or general anesthesia- a closed reduction is a manual procedure that allows broken bones to be realigned without the need for incisions.  

Using internal fixation devices to anchor fractured bones in the proper position- Open Reduction and Internal Fixation (ORIF) entails making incisions to access and rectify the broken bones.  

MMF is a common treatment for some kinds of mandibular fractures that entails connecting both lower and upper jaws together in order to immobilize them.  

When there is severe bone loss or face skeleton fractures- bone grafting is used.  

Repairing orbital fractures requires a number of treatments- including as reconstructing the orbital floor- treating soft tissue damage surrounding the eyes- and stabilizing the broken bones with plates and screws.  

use-of-phases-in-managing-facial-fractures

Initial Evaluation and Diagnosis: Quick and detailed evaluation matters to get a good look at the size and type of facial fractures. This step comprises of external examination- computed tomography imaging studies- and patent assessment for accessing concomitant injuries and planning the right treatment. 

Acute Management: First-aid treatment might be extremely important in some cases- especially when fractures mean real danger and require an immediate intervention within 24 hours of a trauma. The first aspect of shock management where airway is considered- bleeding is controlled and resuscitation is started is highlighted. 

Surgical Intervention: If the fracture is more complex- or if it involves a joint- surgeons may have to do open reduction and internal fixation (ORIF) to help restore normal anatomy. Unlike adults- the reduction and fixation methods range widely- and are dependent upon the patient’s age- as well as location and type of fracture. 

Postoperative Care and Follow-up: In the postoperative period- wound care of monitoring the healing process- pain management- treatment of the risk of infections and follow up of the recovery need to be ensured. Doing consistent follow-up check-ups- no matter how complicated the condition- is of utmost significance to evaluate progress- identify any challenge and enhance longevity. 

Medication

Future Trends

Media Gallary

References

Maxillary Fracture:ncbi.nlm.nih