Fractures of the bones of the face appear for a number of reasons, most often associated with sports. They can result from contact between athletes (headbutts, punches, elbows), contact with gear and equipment (ball, puck, handlebars, gym equipment) or contact with the environment or obstacles (trees, walls). Some sports (football, baseball, hockey) have a high percentage of facial injuries.
Fractures of the bones of the face
The facial part of the skull has a complex structure. It consists of the frontal bone, zygomatic, orbital bones, nasal, maxillary and mandibular and other bones. Some of them are located deeper in the facial structure. Attached to these bones are muscles that support chewing, swallowing, and speaking.
One of the most common fractures of the facial bones is a broken nose. Injury to other bones may also occur. May be broken as one boneso a few. Multiple fractures are more likely to result from a car or other accident. Fractures can be unilateral (occur on one side of the face) or bilateral (on both sides of the face). Below you can see in the photo fractures of the facial bones.
Is this injury a serious problem
Some types of facial fractures are relatively minor, while others can cause serious harm and even be life-threatening. That's why it's important to get the right diagnosis and treatment done before serious complications can occur.
Facial nerves and muscles responsible for sensation, facial expressions and eye movements are located near the bones of the face. In close proximity is the brain and the central nervous system (CNS). Fractures of the facial bones can lead to cranial nerve damage, depending on the specific type and location of the fracture. Fractures of the orbital bone (eye socket) can lead to vision problems. Nasal fractures can make breathing or smelling difficult. In addition, fractures of the jaw bones can cause breathing problems or make eating and speaking difficult.
If an injury to the facial bones occurs, the victim should immediately seek medical attention.
Types of fractures
There are several main types of fractures of the facial bones of the skull. They are classified for various reasons, in particular, according to their localization. For fractures of the bones of the facial skeleton, ICD 10 includes rubricators thatdetermine the nature of the damage depending on the type of injury: it can be closed, open or indefinite.
By severity, fractures of the facial bones are divided into 4 groups:
- with a first-degree fracture, the skin is damaged by a fragment from the inside;
- with a fracture of the second degree, there is a superficial wound of the skin and soft tissues, a slight clogging of the wound;
- Third-degree fracture causes massive soft tissue injuries that may accompany injuries to major vessels and peripheral nerves;
- with a fourth-degree fracture, subtotal or total amputation of the segments is noted.
Fractures of the nasal bone
This type is the most common. The nasal bone consists of two thin bones. It takes less effort to break the nasal bones than other bones because they are quite thin. With a fracture, the nose, as a rule, looks deformed, pain appears. Swelling can make damage assessment difficult. Nosebleeds and bruising around the nose are common symptoms of this injury.
Fractures of the frontal bone
The frontal bone is the main bone in the forehead. The fracture most often occurs in the middle of the forehead. This is where the bones are thinnest and weakest. Damage can cause the bone to be pressed inward. It takes considerable force to break the frontal bone, so this injury can often be accompanied byother trauma to the face, skull, or neurological damage. This can cause liquorrhea (leakage of cerebrospinal fluid), eye injury, and damage to the nasal passage.
Fractures of the zygomatic bones
The cheekbones are attached at several points to the upper jaw and bones of the skull. With their fractures, injuries to nearby bones are also possible, in particular, damage to the sinuses of the upper jaw. As a result of injury, the zygomatic bone, zygomatic meadows, or both can break.
According to the patients themselves, such fractures often cause facial asymmetry. Fractures of the zygoma make up the majority of fractures of the maxillofacial bones.
Orbital fractures
There are three main types of these injuries:
- Fracture of the orbital rim (outer edge), the thickest part of the eye socket. It takes a lot of force to break this bone. Such a fracture may be accompanied by damage to the optic nerve.
- Fracture of the rim extending to the lower edge and bottom of the orbit. In this case, there is a fracture of the facial bone under the eye.
- Fracture of the thinnest, lower part of the eye socket. In this case, the orbital rim remains intact. Eye muscles and other structures can be injured. With such an injury, it is possible to limit the mobility of the eyeball.
Fractures of midface bones
In blunt trauma, fractures often occur along the three lines that run along the joints of the bones, in the thinnest and weakest places, as well as wherephysiological holes. According to the Le Fort classification, there are three main types of fractures, but their variations can also occur:
- Fracture Le Fort I. With such an injury, the zygomatic bone and upper jaw break, they are completely separated from the other bones of the skull. Often accompanied by a skull fracture.
- Fracture Le Fort II. The fault line runs from the bottom of one cheek, under the eye, through the nose, and to the bottom of the other cheek.
- Le Fort fracture III. In this case, the alveolar process breaks off, the fault line passes through the nasal floor and maxillary sinuses. With such an injury, the maxillary ganglion is damaged.
Injuries of the lower jaw
In case of fractures of the lower jaw, the angle of the lower jaw, the condylar and articular processes, and the chin are most often damaged. According to localization, fractures of the body and branches of the lower jaw are distinguished.
Reasons
Fractures of the bones of the face occur for a variety of reasons:
- traffic accidents;
- sports injury;
- accidents, including at work;
- falling from a height;
- falling from a stationary or moving vehicle;
- injury caused by an object or another person;
- gunshot wounds.
Symptomatics
Any fracture causes pain, bruising and swelling. Most of the symptoms depend on the location of the fracture.
When the lowerjaws observed:
- profuse salivation;
- trouble swallowing;
- bite change;
- change in skin color;
- jaw displacement.
In case of a fracture of the upper jaw, the following are possible:
- nosebleed;
- swelling under the eyes and on the eyelids;
- face pulling.
Symptoms of a broken nose may include:
- discoloration under the eyes;
- blockage of one or both nostrils or displacement of the septum;
- distorted nose.
Orbital fracture symptoms:
- blurred, impaired or double vision (diplopia);
- difficulty moving eyes left, right, up or down;
- swollen forehead or cheek or swelling under the eyes;
- sunken or protruding eyeballs;
- redness of the whites of the eyes.
First aid
Before the victim is sent to the doctor, he must be given first aid. Cold should be applied to the site of the injury. It is impossible to set the displaced bone fragments on your own. In this case, you can apply a bandage and take the victim to a medical facility.
Diagnosis
First of all, the presence of any life-threatening injuries is determined. The physician should check to see if anything is blocking the airways or nasal passages, evaluate pupil size and response, and determine if there is any damage to the central nervous system.
The doctor then investigates how and when the injury occurred. The patient or histhe representative must provide information on whether there are any other medical problems, such as chronic diseases, previous facial injuries or surgeries. This is followed by a physical examination of the face for signs of asymmetry and impaired motor functions.
May require CT scan for diagnosis.
An x-ray may not be needed for a broken nose if the swelling is limited to the bridge of the nose, the patient can breathe through each nostril, the nose is straight, and there is no blood clot on the septum. Otherwise, x-rays are taken.
Your doctor may also order a computed tomography (CT) scan to determine the exact location and type of fracture or fractures.
Treatment
The type of treatment will depend on the location and extent of the injury. The goal of treating facial fractures is to restore the normal appearance and function of the affected areas.
A fractured face can heal without medical intervention if the broken bone remains in its normal position. Severe fractures usually need to be treated. Treatments include the following.
The doctor puts broken bones in their normal position without making any incisions. As a rule, this method is used for a broken nose.
Endoscopy: Using an endoscope (a long tube with a camera and a light) placed inside through a small incision, the doctor examines the damage from the inside. Small pieces of broken bone may be removed during an endoscopy.
Medications:
- decongestants that help reduce swelling in the nose and sinuses;
- painkillers;
- steroidal anti-inflammatory drugs to reduce swelling;
- antibiotics in case of risk of infection.
Orthodontic treatment for damaged or broken teeth.
Surgery: A doctor uses wires, screws, or plates to connect broken bones in the face.
Reconstructive surgery may be required to correct parts of the face that are deformed by trauma. Sometimes it is necessary to remove parts of broken facial bones and replace them with grafts.
Rehab
After surgery, the patient is in the hospital for at least ten days. The recovery time is influenced by such factors as the time to seek help from the moment of injury, the location and nature of the fracture. Full recovery after a fracture of the bones of the facial skeleton occurs on average in a month. During this period, increased loads should be excluded, the patient is prescribed a calcified diet. After recovery, the patient may take vasoconstrictor nasal preparations for some time as prescribed by the doctor.
Risks
Treating a facial fracture can result in swelling, pain, bruising, bleeding and infection. Scars may remain after the operation. During treatment, nearby tissue and nerves may be damaged, resulting in numbness. During the operation, the sinuses may be damaged. Even with surgery, it is possible to savefacial asymmetries, vision changes. Bone and tissue grafts can move out of place, and then another operation is required. Plates and screws used to fix bones can become infected or need to be replaced. There is also a risk of blood clots.
The consequences of fractures of the facial bone without treatment can be facial asymmetry, pain in the face, eyes or blindness. Bleeding can block the airways, making it difficult to breathe. It is also possible to bleed into the brain, which can lead to seizures and be life-threatening.
Preventive measures
It is impossible to completely prevent fractures of the bones of the facial skull. However, there are a number of measures that can reduce injury rates:
- wearing a helmet when riding a bike or motorcycle;
- using a seat belt in a car;
- use of protective equipment (helmets, masks) while playing sports
- compliance with safety regulations at work.
