A facial fracture is a broken bone in the face. The face has a complex bone structure. The facial skeleton consists of the frontal bone (forehead), zygomas (cheekbones), orbital bones (eye sockets), nasal bones, maxillary bones (upper jaw) and mandible (lower jaw). There are many other bones that are found deeper within the facial structure. Muscles required for chewing, swallowing and talking are attached to these bones.
Nasal fractures (broken nose) are the most common. Fractures to other facial bones can also occur. Only one fracture may be present, or there may be several broken bones. Multiple fractures are more likely to occur during a motor vehicle accident or other high-impact accident. Fractures may be unilateral (occurring on one side of the face) or bilateral (both sides of the face).
Is a facial fracture a serious problem? Some types of facial fractures are relatively minor, but others may cause irreversible damage and can even be life-threatening. That is why it is important to seek proper diagnosis and treatment before serious complications can occur.
Facial nerves and muscles responsible for sensations, expressions and eye movements are positioned near the facial bones. The face is close to the brain and central nervous system (CNS). Fractures may result in damage to cranial nerves, depending on the particular type and location of the fracture. Fractures to the orbit (eye socket) may result in problems with vision. Fractures of the nose may make it difficult for the injured person to breathe or smell. Also, fractures of the jawbones may cause breathing problems or make it difficult to chew, speak, or swallow.
If a facial injury occurs, the injured person should seek immediate medical attention. Complex fractures may cause irreversible damage and can even be life-threatening. Some facial fractures can cause problems with the respiratory system, airway passages, central nervous system or vision.
What are the kinds of facial fractures?
There are several main types of facial fractures.
Nasal bones (broken nose)—Nasal bone fractures are the most common type of facial fracture. The nasal bone is comprised of two thin bones. It takes less force to break the nasal bones than other facial bones because they are thin and prominent. Usually, the nose looks deformed or feels sore to the touch after a fracture. Swelling in the area might make it more difficult to assess how much damage has occurred. Nosebleeds and bruising around the nose are common symptoms of a nasal fracture.
Frontal bone (forehead) fractures—The frontal bone is the main bone in the forehead area. A high-impact injury to the head can cause a fracture of the frontal bone and floor of the sinuses. The fracture is mostly likely to occur in the middle of the forehead. That is where the bone is the thinnest and weakest. An injury may cause the bone to be indented (pushed inward). Substantial force is required to fracture the frontal bone, so often other injuries to the face and skull or neurological trauma may be present. Associated problems may include leakage of the cerebrospinal fluid, eye injuries and damage to the sinus ducts.
Zygomaticomaxillary fractures (broken cheekbone/upper jaw)—The zygomas (cheekbones) are attached at several points to the upper jaw (maxilla) and bones of the skull. Fractures to the cheekbone(s) might also involve breaks in other facial bones nearby.
Orbital fractures (eye socket)—There are three main types of orbital fractures.
Orbital rim fracture—The outer rim is the thickest part of the eye socket. It requires a lot of force to break the bone. Many other injuries may accompany an orbital rim fracture, such as damage to the optic nerve.
Blowout fractures—The orbital rim remains intact in this case, but a crack forms in the thin bone at the lower part of the eye socket. The eye muscles and other structures can become entrapped in the break and prevent the eyeball from moving normally.
Direct orbital floor fracture—This is a rim fracture that extends into the lower socket.
Mid-face (Le Fort fractures)--Blunt force trauma tends to cause fractures along three lines of weakness in the mid-face. One characteristic of all types of Le Fort fractures is the fracture of the pterygoid processes, part of the sphenoid bone. There are three main types of Le Fort fractures, but there may be individual variations.
Le Fort I. The fracture extends above the upper jaw (maxilla).
Le Fort II. The fracture extends from the lower part of one cheek, below the eye, across the bridge of the nose, and to the lower part of the other cheek.
Le Fort III. The fracture extends across the bridge of the nose and the bones surrounding the eyes.
Mandible (lower jaw)—The mandible holds the lower teeth in place and moves when you are talking or chewing. Fractures of the lower jaw affect the sections of the lower jaw that supports teeth (called the body), the part where the jaw curves upwards into the neck (the angle) or the knob-shaped joint at the top of the jaw bone (the condyle) or the point where the two sides of the lower jaw are joined (the symphysis). Fractures of the mandible may be accompanied by broken or loose teeth.
What causes facial fractures?
High-impact accidents, such as motor vehicle collisions
Interpersonal trauma or domestic violence
What are the symptoms of a facial fracture?
Symptoms of a fracture to the face may include pain as well as bruising, swelling, or tenderness.
Symptoms of a nose fracture may include:
Purplish patch on skin caused by leakage of blood from ruptured blood vessels (bruising or ecchymosis)
Discoloration under the eyes
Blockage of one or both nostrils or a deviated septum
Twisted or crooked nose or indented bridge
Symptoms of an orbital fracture may include:
Blurry, decreased or double vision (diplopia)
Difficulty in moving eyes left, right, up or down
Swollen forehead or cheek or swelling under the eyes
Flatness of the cheeks
Sunken or bulging eyeballs
Facial numbness near the injury
Blood or discoloration in the white part of the eye
Symptoms of upper or lower jaw fractures:
Trouble with chewing, eating, or speaking
Loose, broken or missing teeth
Teeth not fitting together properly
Cheek pain when opening the mouth
How are facial fractures diagnosed?
First of all, medical personnel will determine whether there are any life-threatening injuries. These conditions have to be addressed immediately before a more thorough examination of the face is performed. A physician will check to see if there is anything blocking the airways or nasal passages, assess pupil size and reactions, and look for any damage to the central nervous system.
The doctor will then ask questions about how and when the injury occurred. The patient or caregiver should provide information about whether the patient has any other medical problems or previous problems, such as past facial injuries or surgery. A physical exam will be performed to check the face for signs of asymmetry (one side appears different from the other) and damage to motor functions (movement). The doctor will look at the face from several angles and examine the bones of the face by palpating (gently pressing on) them.
Signs of orbital fractures may include differences in the position of the eyeballs or sunken eyes. If the measured distance between the eyes is greater than normal, it may indicate a nasoethmoid fracture. Two-dimensional face CT scans and 3-dimensional reconstructive scans may be required for diagnosis and after surgery to confirm correction of the fracture.
If the nose is broken, X-rays might not be required if the tenderness and swelling are confined to the bony bridge of the nose, the patient can breathe through each nostril, the nose is straight, and no blood clot is found at the septum. Otherwise, a series of plain X-rays may be taken.
If a fracture is suspected, the doctor may order a computer tomography scan (CT scan) to determine the exact location and type of the fracture or fractures. A basic series of X-rays may be sufficient in some cases to assess the fracture if a CT scan cannot be performed or there is no indication of a midface or maxillary fracture.
In cases where there are complex fractures of the midface (LeFort fractures), two-dimensional face CT scans and 3-dimensional reconstructive scans may be required for diagnosis or before surgery to improve the outcome during facial reconstructive surgery.
How are facial fractures treated?
A doctor may prescribe pain-relieving drugs as well as oral steroids to ease swelling. The doctor will prescribe antibiotics if there is a high risk of infection.
In general, fractures may be treated by performing a closed reduction (resetting the broken bone or bones without surgery) or an open reduction (surgery that requires an incision to reposition the fractured bones). For a complex fracture with multiple broken bones, reconstructive surgery is required.
The type of treatment will depend on the location and extent of the injury. The aim of treatment for facial fractures is to restore the normal appearance and function of the injured areas.
Life-threatening conditions, such as blockage of the airways, cardiovascular problems, or brain or nervous system injuries, must be treated immediately.