Facial Fracture

What is a facial fracture?

A facial fracture is a condition when one or more bones in your face are broken. Your face is made up of many bones connected to each other. These include the bones of your orbit (around your eye), zygoma (cheekbones), nose, and jaw. These bones may be broken when you have an injury to your face. A break in one or more of your facial bones may also cause damage to your nearby tissue. The muscles or nerve around your eyeball may also get pinched between these fractures. Having your facial fracture treated may resolve your swelling and pain. Treatment may also fix your broken facial bones and save your life.

What may cause a facial fracture?

A facial fracture may be caused by any of the following:

• Accidents: Motor vehicle accidents are a common cause of facial fractures. A facial fracture may occur if you hit your face on the steering wheel of your car. Not having a seatbelt on during a motor vehicle accident may increase your risk of a facial fracture. Motorcycle and bicycle accidents may also cause a facial fracture. Your risk is higher if you do not wear a helmet when riding a motorcycle or bicycle. Falling and hitting your face on the ground may also cause a facial fracture. Accidents causing a facial fracture may also occur at work.
  
  
• Assault: Being hit in the face during an assault or violent physical attack may cause a facial fracture.
  
  
• Gunshot wounds: A bullet from a gunshot that hits your face may cause a facial fracture .
  
  
• Sports: Facial fractures more commonly occur in people who play sports such as baseball and football. Facial fractures may occur if you are hit in the face with a bat, ball, or other hard object.

What are the signs and symptoms of a facial fracture?

You may have any of the following:

• Eyes:
  
  
  • Blurry vision (eyesight) or seeing double.
    
    
  • Decreased eye movement or pain when moving your eye.
    
    
  • Seeing objects such as floating specks.
    
    
  • Sunken or displaced eye (your eye is not in its normal position).
    
    
  • Swollen eyelids.
    
    
  • Trouble looking up.
  
  
• Face:
  
  
  • Bruising around or under your eye, midface, or cheek.
    
    
  • Numbness of your upper lip, side of your nose, or cheek.
    
    
  • Swollen or flattened cheek.
  
  
• Teeth:
  
  
  • Broken teeth or tooth loss.
    
    
  • Malocclusion (upper and lower teeth do not fit together).
    
    
  • Pain when moving your jaw.
    
    
  • Trouble clenching (pressing your teeth together).
    
    
  • Trouble closing your mouth.

How is a facial fracture diagnosed?

Your caregiver will do a complete physical exam. Tell your caregiver about your symptoms and when they started. Your eyesight, pupils (round, dark center of your eyes), and eye movements will be checked. Your caregiver may use an ophthalmoscope (special tool) to help him see the inside of your eye. Your caregiver may also check your face for cuts or punctures (holes) in your skin. You may also need one or more of the following:

• Imaging tests: Certain tests use a special dye to help pictures show up better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may be allergic to some dyes. Tell your caregiver if you are allergic to shellfish, or have other allergies.
  
  
  • Computed tomography scan: This test is also called a CT scan. A special x-ray machine uses a computer to take pictures of your head. It can show broken bones, tissue, and blood vessels.
    
    
  • Ultrasound: An ultrasound is a simple test that looks inside your head. Sound waves are used to show pictures of your facial bones and tissue on a TV-like screen. This test may help your caregiver decide the best treatment for your facial fracture.
    
    
  • X-rays: An x-ray is a picture of your facial bones and tissue. X-rays may be needed to help your caregiver see your broken facial bones better. You may need to have more than one x-ray picture taken.
  
  

How is a facial fracture treated?

A facial fracture may be left to heal on its own. No treatment may be necessary if your broken bone stays in its normal position. Injuries causing severe fractures may need to be repaired. You may need any of the following:

• Closed reduction: During this procedure, your caregiver moves your broken bones back to their normal position. Closed reduction is often done when you have a broken nose. You will not need an incision (cut) for this procedure. Ask your caregiver for more information about closed reduction.
  
  
• Endoscopy: This test uses a scope to look inside your sinuses and orbital cavity (eye socket). The scope is a long tube with a lens and light on the end. The scope is placed between your upper gums and lip and into the sinus behind your cheekbone. The scope may also be put through a small incision in your scalp and into the sinus behind your forehead. The scope may help your caregiver see your facial fracture better. During an endoscopy, small pieces of your broken bone may be removed. Special devices may be placed to support the broken bones in your face.
  
  
• Medicines:
  
  
  • Antibiotic medicine: This medicine may be given if you have an open wound (sore). Antibiotic medicine is used to treat an infection caused by germs called bacteria.
    
    
  • Decongestant medicine: Your caregiver may give you decongestants to decrease swelling in your nose and sinuses (air filled spaces). Decongestant medicine may also help you breathe easier.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain.
    
    
  • Steroid medicine: This medicine may be given to decrease swelling in your face.
  
  
• Orthodontic treatment: You may need to see a caregiver who fixes damaged or broken teeth. Orthodontic treatment may also be done if you have a malocclusion from your injury.
  
  
• Surgery:
  
  
  • Open reduction and internal fixation: This surgery is also called ORIF. During an ORIF, your caregiver makes an incision over your fracture site to look at your broken bones. Special wires, screws, or plates may be used to join your broken facial bones together. This surgery is done to hold your bones in place and keep them from moving while they heal.
    
    
  • Reconstructive surgery: Reconstructive surgery may be needed to fix areas of your face that are misshapen by your injury. Your caregiver may need to remove pieces of your broken facial bones and replace them with a graft. A graft is healthy tissue taken from another area of your body or from a donor (another person).

What can I do to help myself?

• Apply cold packs. Ice causes blood vessels to constrict (get small) which may help decrease swelling, pain, and redness. Do not sleep with the ice pack on your face because you may get frostbite.
  
  
• Clean your mouth regularly. Having an injury to your mouth area may make it hard to remove food pieces and clean your teeth. Your caregiver will show you the best way to do this so you do not hurt yourself. A water pick or a child-sized soft toothbrush may work well to clean your mouth.
  
  
• Do not sleep on the injured side of your face. Pressure on the area of your injury may cause further damage.
  
  
• Keep your head above the level of your heart. Elevating your head may help decrease swelling and improve the blood flow to your face. You can elevate your head by putting pillows under your head and shoulders.
  
  
• Sneeze with your mouth open. Sneezing with your mouth open helps decrease pressure on your broken facial bones. Too much pressure from a sneeze may cause your broken bones to move and cause more damage.
  
  
• Try not to blow your nose. If you have a fracture near your eye, blowing your nose may cause more damage. Blowing your nose may pinch the nerve of your eye causing permanent damage.

How can I prevent having a facial fracture?

• Make sure your car has an air bag installed for safety.
  
  
• Wear a helmet when riding a bicycle or a motorcycle.
  
  
• Wear a seatbelt at all times when you are inside a motor vehicle.
  
  
• Wear protective headgear and eyewear during sporting activities.

Where can I find more information?

Having a facial fracture may be hard. You may sad, scared, and have a hard time coping with your condition. You may feel embarrassed if your face is misshapen. Talk to your caregivers, family, or friends about your feelings. Contact the following:

• American College of Surgeons
  633 N. Saint Clair St.
  Chicago , IL 606113211
  Phone: 1- 312 - 2025000
  Phone: 1- 800 - 6214111
  Web Address: http://www.facs.org
  

When should I call my caregiver?

Call your caregiver if:

• You are bleeding from a wound on your face.
  
  
• You are seeing double or suddenly have problems with your eyesight.
  
  
• You have chest pain or trouble breathing that is getting worse over time.
  
  
• You have questions or concerns about your condition, treatment, or care.

When should I seek immediate help?

Seek care immediately or call 911 if:

• You have clear or pinkish fluid draining from your nose or mouth.
  
  
• You have facial asymmetry (uneven features).
  
  
• You have numbness in your face.
  
  
• You have worsening pain in your eye or face.
  
  
• You suddenly have trouble breathing.
  
  
• You suddenly have trouble chewing or swallowing.
  
  
• You suddenly feel lightheaded and have trouble breathing.
  
  
• You have new and sudden chest pain. You may have more pain when you take deep breaths or cough. You may cough up blood.
  
  
• Your arm or leg feels warm, tender, and painful. It may look swollen and red.

Care Agreement

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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