An oral and maxillofacial surgeon is charged with the delicate and intense treatment of facial injuries. This professional must be well versed in emergency care, acute treatment and long-term reconstruction and rehabilitation – not just for the patient’s physical well-being, but for his emotional stability as well. Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.
Oral and maxillofacial surgeons, on staff at local hospitals, deliver emergency room coverage for facial injuries, which include the following conditions:
- Intra oral lacerations
- Avulsed (knocked out) teeth
- Fractured facial bones (cheek, nose or eye socket)
- Fractured jaws (upper and lower jaw)
The Nature Of Maxillofacial Trauma
There are a number of possible causes of facial trauma: motor vehicle accidents, accidental falls, sports injuries, interpersonal violence, and work-related injuries. Facial injuries include injuries to the teeth as well as severe injuries to the skin and bones of the face. Typically, facial injuries are classified as soft tissue injuries (skin and gums), bone injuries (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).
Bone Injuries Of The Maxillofacial Region
Fractures of the bones of the face are treated in a manner similar to that of fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, the patient’s age, and the general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.
One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain other types of fractures of the jaw are best treated by the surgical placement of small plates and screws at the involved site. This technique of treatment can often allow for healing and obviates the necessity of having the jaws wired together. This technique is called “rigid fixation” of a fracture. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many patients, allowing them to return to normal function more quickly.
The treatment of facial fractures should be accomplished in a sensitive, thorough, and predictable manner involving the fewest incisions possible and minimally affecting the patient’s appearance.
Injuries To The Teeth & Surrounding Dental Structures
Isolated injuries to teeth are quite common, and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth that have been displaced or knocked out. These types of injuries are treated by one of a number of forms of splinting (stabilizing by wiring or bonding teeth together). If a tooth is knocked out, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better the chance that it will survive. The patient should see a dentist or oral surgeon as soon as possible. In addition, the patient must never attempt to wipe the tooth off, since remnants of the ligament that hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists, such as endodontists or restorative dentists, may be called upon to assist. For instance, an endodontist may be asked to perform root canal therapy, or a restorative dentist may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.
The proper treatment of facial injuries is now the realm of specialists who are well versed in emergency care, acute treatment, long-term reconstruction, and rehabilitation of the patient.