Facial trauma

Facial trauma accounts for 7% of emergency department visits. They can result from falls, accidents occurring during activities of daily living, sports and recreational activities, violence, motor vehicle accidents, animal attacks, and self-inflicted injuries. 

Prompt medical assistance is required for facial trauma, particularly if there is: 

• airway difficulty,  
• drowsiness, nausea, vomits,  

• blurred vision,  
• pulsatile eye or pupil asymmetry,  
• neck growing mass (a possible sign of bleeding in the neck);  
• or deep facial wounds and open fractures (exposed bone). 

Fortunately, the majority of facial fractures are non-life-threatening. The most frequent fractured bones are the zygomatic (cheek bone) and the nasal bones. 

Surgery aims to restore facial morphology and functions to the best possible extent. The decision to operate a facial fracture is based on the assessment of the potential benefits versus the risk of the intervention. 

Upon uncomplicated fractures, when the bone is aligned without compromising morphology or function, it is usually possible to manage the fracture conservatively without surgical intervention. 

When surgery is needed for uncomplicated fractures, it tends to be easier to operate them a few days after the impact, with less soft tissue edema. 

Depending on the type of facial lesions, the prognosis of having some sort of late complications is variable, depending on the severity and type of injury.  

Some common complications may include: 

Skin scar revision, which may be necessary if a scar is prominent or if there is a noticeable difference in skin color (please refer to fat graft vídeo and page) 

In cases where bone fixation material has been used, there may be a need for revision of the ostheosynthesis to ensure that the bone is still properly aligned and healed. Bone realignment may also be necessary if the initial treatment did not result in proper alignment of the fractured bone. 

In addition, some patients may experience infections or non-healing fractures that require further medical ou surgical revision. 

Depending on the nature and severity of the facial trauma, nerve damage can occur and may require specialized management, which can involve non-invasive pharmacological treatments (including those provided by chronic pain teams) or surgical revision. 

It is important for patients to receive timely medical attention for facial trauma to minimize the risk of complications. Following the treatment plan provided by the medical team and actively participating in the healing process can also help to reduce the risk of late complications. Patients should also be sure to attend all follow-up appointments to monitor the healing progress and address any potential issues as soon as possible. 

https://pubmed.ncbi.nlm.nih.gov/28496386/ 

https://pubmed.ncbi.nlm.nih.gov/30454777/  

https://pubmed.ncbi.nlm.nih.gov/31972757/