Facial traumatology

The face is one of the most exposed areas of the body. In the event of an accident, fall, blow or sports trauma, it can suffer bone fractures that require specialized treatment. With the right treatment, the volumes, symmetry and functions of the face can be restored, minimizing scarring and after-effects.

The most common causes of facial fractures

• Road or bicycle accidents,
• Falls (domestic, sports-related or due to loss of consciousness)
• Assaults or fights
• Playing certain contact sports
• Occupational accidents

These injuries can affect a single bone or several structures at once (complex fractures).

What are the warning signs?

Depending on the bone involved, symptoms may vary. The most common signs are :

• Swelling, bruising (black eye), deformity
• Localized pain, especially on palpation or movement
• Dental occlusion disorders (teeth that no longer fit together properly)
• Difficulty opening mouth, chewing or speaking
• Numbness or loss of sensitivity (especially under the eyes or on the chin)
• Nasal bleeding, nasal tip deviation
• Double vision (diplopia) or reduced eye mobility
• Facial indentation or asymmetry (especially cheekbones)

A facial CT scan is often necessary to confirm the diagnosis and guide the surgical strategy.

What are the main facial fractures?

Fracture of the superciliary arch and orbital rim.

These fractures may involve the upper rim of the orbit, and sometimes extend to the inner wall or roof of the eye socket. They are common after a direct blow to the forehead or eye.

They require surgery if they cause deformity, eye damage or visible bone ingrowth.

Surgery involves repositioning the bone fragments and fixing them in place with mini-plates, often through an incision concealed in a natural eyebrow crease. In some cases, the floor of the orbit is also affected, and must be reconstructed to avoid insertion of one of the muscles responsible for eye movement.

Fracture of cheekbone (zygomatic bone)

The cheekbone is a key bone in the structure of the face. It can fracture singly or in association with other bones (known as a “complex” fracture).

Typical signs are :

• Cheek sagging or flattening
• Swollen eyes, reduced eye mobility, double vision
• Numbness of the cheek or upper lip
• Difficulty opening mouth (if zygomatic arch blocks temporal muscle)

Surgery aims to reposition the cheekbone in its original axis and projection, then fix it with mini-plates, through small, discreet incisions (often inside the mouth, in the lower eyelid or in the temple, depending on the complexity of the case).

Nose bone fracture

Nasal fractures are very common. They can lead to :

• Nose pain and swelling
• Heavy bleeding
• Deviated nasal septum
• Respiratory discomfort

When the fracture is displaced, it may be necessary to perform a nose reduction under general or local anaesthetic, ideally within 10 days of the trauma.

If the septum is affected, or if breathing remains impaired, secondary surgery (septoplasty or rhinoseptoplasty) may be proposed at a distance from the trauma.

Fracture of lower jaw (mandible)

The mandible can fracture in several areas: chin (symphysis), angle, ascending ramus, neck of condyle…

Common symptoms include :

• Modified dental occlusion
• Chewing pain
• Limited or blocked movements
• Abnormal mobility of a tooth segment
• Numbness of the lower lip

Depending on the area and displacement, the treatment can be :

• Orthopedic: elastics or splints in simple, stable cases (non-displaced)

Surgical: endo-buccal reduction and fixation with titanium plates and screws (without visible scarring)

• The return to a normal diet is gradual. Close monitoring is maintained until consolidation.

What happens after surgery?

The after-effects depend on the type of fracture and the fractured bone, but overall :

• Oedema is common in the first few days, often impressive but transient,
• Pain is well controlled by conventional analgesics,
• A soft diet is recommended for 2 to 3 weeks,
• Rigorous oral care is sometimes required (rinsing, brushing).
• A work stoppage of 1 to 3 weeks may be prescribed, depending on the activity.
• Resumption of contact sports is delayed by 1 to 3 months
• Check-up by an ophthalmologist for orbital fractures

Regular follow-up is organized to verify proper consolidation, correct any persistent disorders, and ensure a satisfactory aesthetic result.