Oral and maxillofacial surgeons are trained, skilled and uniquely qualified to manage and treat Facial Trauma. Our Surgeons are on staff at Swedish Medical Center and provide emergency room coverage for facial injuries including:
- Facial lacerations
- Intraoral lacerations
- Avulsed (knocked out) teeth
- Fractured facial bones (cheek, nose or eye socket)
- Fractured jaws (upper and lower jaw)
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 “hands on” experience and an understanding of how the treatment provided will influence the patients long term function and appearance.
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 account for most traumatic injuries to the face. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones. Typically, facial injuries are classified as either soft tissue injuries (skin and gums), bony injuries (fractures), or injuries to special regions (such as eyes, facial nerves or the salivary glands).
Soft tissue injuries of the maxillofacial region
When soft tissue injuries, such as lacerations, occur on the face, they are repaired by “suturing”. In addition to the obvious concern of providing a repair which yields the best cosmetic result possible, care is taken to inspect for and treat, injuries to structures such as facial nerves, salivary glands and salivary ducts (or outflow channels). Drs. Tidwell and Kutcipal are well-trained, board certified oral and maxillofacial surgeons and are proficient at diagnosing and treating all types of facial lacerations.
Bone injuries of the maxillofacial region
Fracture of the bones of the face are treated in a manner similar to the 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, and the age and general health of the patient. When an arm or 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 fractures.
One of these options involves wiring the jaws or using elastic bands to hold the jaws in the correct relationship during the healing period. However, certain other types of fractures of the jaws are best treated and stabilized by the surgical placement of small “plates and screws” at the fracture site. This technique of treatment is called “rigid fixation” and minimizes the need for having the jaws wired together. The relatively recent development and use of “rigid fixation” has profoundly improved the recovery period for many patients by allowing them to return to normal function more quickly.
The treatment of facial fractures should be accomplished in a thorough and predictable manner. Importantly, the patients facial appearance should be minimally affected. Every attempt is made to minimize the number of skin incisions used to access the facial bones. At the same time, if incisions in the skin are required they are designed to be small and, whenever possible, are placed so that the resultant scar is “hidden”.
Injuries to teeth and surrounding dental structures
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons are usually involved in treating fractures in the supporting bone or in replanting teeth, which have been displaced or “knocked out”. These types of injuries are usually treated by stabilizing by wiring or bonding teeth together. If a tooth is “knocked out”, it should be placed in salt water or milk as soon as possible. The sooner the tooth is re-inserted into the tooth socket, the better for the long-term survival of the tooth. The patient should see a dentist or oral surgeon as soon as possible following this type of injury. Never attempt to “wipe the tooth off”, since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who 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, well versed in the emergency care, acute treatment and long term reconstruction and rehabilitation of the patient.