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Treating and Preventing Facial Injury

Maxillofacial injuries are also called facial trauma. They include any kind of injury to the mouth, face & jaw. Almost all people will have either experienced or know someone who has experienced this kind of an injury. In most cases, maxillofacial injuries are a result of a motor vehicle accident, a sports mishap, an act of violence, on-the-job accident, an accident at home.

If the person is disoriented, unconscious, dizzy, nauseated, incapacitated or dizzy, call 911 without delay. Do not try to move the person yourself. Even if none of these symptoms are present, but that injury is severe/ if you are not sure about the severity, it is crucial that you take the person to an ER as soon as possible. 

The Specialization

At the hospital, in most cases, the person will be seen by different medical personnel, and one may be an oral & maxillofacial surgeon. These surgeons are dental surgical specialists and are specifically trained to effectively repair injuries to the jaws, mouth and face. After 4 years of dental school, oral & maxillofacial surgeons complete 4/more years of surgical residency training in a hospital setting.

This might include rotations in related medical fields, such as general surgery, plastic surgery, internal medicine, otolaryngology, anesthesiology, emergency medicine as well as other medical-specialty areas. At the end of this highly- demanding program, oral & maxillofacial surgeons are very well-prepared to perform the complete scope of their specialty. It includes emergency care for the jaws, teeth, mouth, and the associated facial structures.

Treating Facial Injury

There are different types of facial injury. One of the most common types takes place when the bones break. Fractures can take place in the upper jaw, lower jaw, cheekbones, palate, eye sockets & combinations of all these bones. The injuries can also affect sight as well as the ability to speak, breathe and swallow. In most cases, the treatment requires hospitalization.

The principles in the treatment of facial fractures are similar to the ones used in the treatment of a broken arm/leg. The different parts of the bones are first lined up & held in that position to allow them to heal, which can take 6/more weeks, based on the age of the patient and the complexity of the fracture. When the maxillofacial fractures are extensive or complex, multiple incisions may have to be made to expose the bones. A combination of plating and wiring techniques may be required.

The repositioning technique that the surgeon uses will be dependent on the severity & location of the fracture. For example, if the upper/lower jaw has broken, metal braces might be affixed to the teeth and wires or rubber bands used to hold the patient’s jaws together. Those who have few/no teeth might need dentures or specially-constructed splints to secure and align the fracture. In some cases, the patients who sustain these types of facial fractures may have other medical problems. The oral & maxillofacial surgeon is fully- trained to coordinate his/her treatment with what other doctors are providing.

In the course of the healing period, the jaws are wired shut and the oral & maxillofacial surgeon prescribes a pureed diet /nutritional liquid. This keeps the patient in good health and speeds-up the healing process. Once the patient has been discharged from the hospital, the patient will be given instructions about continued oral and facial care.

Things to Remember

Though not all facial injuries are always extensive, they are complex as they affect the section of the body that is very critical to eating, breathing, speaking & seeing. Even if a patient has a moderately-cut lip, the skill & expertise of the oral & maxillofacial surgeon becomes indispensable. In case sutures are required, the placement will have to be precise in order to achieve the desired cosmetic result. This is why it is important that a facial injury should not be taken lightly. 

Prevention is the Best Policy

The simple truth is that it is best to avoid injury. This is exactly way oral and maxillofacial surgeons propagate the use of protective mouth guards, automobile seat belts, and appropriate helmets & masks for people who participate in athletic pursuits at just about any level. Anyone can sustain a very serious injury and it’s not just the professional sportspeople who are at risk.

Today, there are a number of innovations in mouth & face guard and helmet technology and these devices are very comfortable to wear. They also very effectively protect the very vulnerable maxillofacial area. Ensure that you and your family are appropriately protected. If you play any sport, wear safety gear that is suitable for that particular sport:

Football: Wear helmets that have face guards & mouth guards. Many helmets that are manufactured for younger players tend to have plastic face guards and these can get bent backwards into the face & cause injury. They should be replaced by strong carbon steel wire-guards.

Baseball: A catcher should never fail to wear a mask. Today, it’s possible to get batting helmets with clear molded-plastic face guards and these can be worn while fielding.

 Ice Hockey: Now a number of ice hockey players have started wearing cage-like face guards that are attached to the helmets. These are much better than  the hard plastic face masks that some goalies wear, since it’s the face guard & the helmet that take the pressure of  the blow instead of the player’s face. Face & mouth guards can be worn for extra protection. These can have hard plastic external mouth guards which are secured with straps

Wrestling: An increasing number of high school athletic associations now require that wrestlers wear appropriate head gear. The strap with a chin -cup holds this gear in place & helps to steady the jaw. There are also  face masks and mouth guards that wrestlers can use

Boxing: In this sport, it is mandatory for boxers to wear mouth guards. Now, there is a new mouth guard, very much like a pacifier. This has a much thicker front and air holes that help in breathing

Lacrosse: Players can use hard plastic helmets that look like baseball batting helmets. These have wire cage face masks.

Field Hockey: Oral & maxillofacial surgeons also recommend that athletes who participate in this particular sport should wear mouth guards. The goalies can wear Lacrosse helmets for extra protection.

Soccer:  Players in this sport should wear mouth-guards for protection. Oral & maxillofacial surgeons also advise that the goalies should wear helmets

Biking: All riders should ideally wear lightweight bike-helmets to ensure that their head is protected

Scooters and Skateboarders: It is recommended that those who ride skateboards and 2-wheeeled scooters should also wear bike helmets

Skiing and Snowboarding: Lightweight helmets are especially made for these sports and help in protecting the maxillofacial area in case of a crash or fall

Horseback Riding: It is recommended that horse riders should wear a mouth guard and a helmet while they are on horseback. 

The other sports in which the participants should use mouth guards are handball, water polo, basketball, karate, judo, rugby and gymnastics. 

A Word about Mouth Guards

There have been a number of advances in engineering & design as well as the materials used in making mouth guards. These are lightweight and sturdy and the wearer is also able to breathe easily. You can find a range of models ranging from the "boil & bite" ones which are inexpensive to the ones that dentist’s custom-make for their patients. The latter tend to be more comfortable.

A mouth protector should always be evaluated from the viewpoint of comfort, retention, tear resistance, ability to speak and breathe and the protection it provides to the teeth, gums & lips. There are 5 criteria that should be considered when you are being fitted for any mouth protector and it should be:

  • - Fitted in such a manner that it doesn’t misalign the jaw & throw-off the bite
    - Strong
    - Lightweight
    - Easy to clean
    - Should cover the lower and/or upper teeth and gums

Experts in the Field

Oral & maxillofacial surgeons encourage sports enthusiasts at all levels of play to wear these mouth guards as well as other protective equipment. The aim is to help change the actual "face" of sports. In case of any mouth or facial injury which requires an ER trip, the athlete who has been injured, the coach or parent should ask that an oral & maxillofacial surgeon be called for consultation. They have the background & training, to deal with these kinds of injuries. In certain cases, they might even detect some "hidden" injury that would otherwise go unnoticed.

© 2005-2012 American Association of Oral and Maxillofacial Surgeons (AAOMS). All rights reserved.

Reprinted with permission from American Association of Oral and Maxillofacial Surgeons.