Patients who have sustained facial trauma, whether from a motor vehicle accident, a fall, interpersonal violence or sports-related injuries, often experience complex physical and emotional trauma. Not only does the long-term function of the treated area need to be considered, but also the final appearance and the emotional impact of the treatment on the patient. Dr. Martin and Dr. Appelblatt are experts in emergency care, acute treatment and long-term reconstruction and rehabilitation. Both doctors received special training in treating facial trauma while working at Trauma Centers (Highland Hospital in Oakland and Bellevue Hospital in New York respectively). During this training, they dealt with complex facial injuries.
While most facial trauma cases treated by oral surgeons involve injuries to the teeth and mouth, injuries to the facial skin, bones of the face and jaw are also quite common. The following is a list of some of the conditions we treat:
- Fractured facial bones (jaws, cheek, nose and orbits)
- Facial lacerations
- Intra-oral lacerations
- Avulsed (knocked out) teeth
Facial injuries are typically grouped into three categories:
- Soft tissue injuries (injuries to the skin, muscles, and gingiva)
- Bone injuries (fractures of bones, damage to teeth)
- Injuries to other areas, such as the eyes, facial nerves or the salivary glands
Soft Tissue Injuries
Soft tissue injuries to the face are typically repaired by suturing. With facial suturing, extra care must be taken to ensure that the damaged area will heal properly and with the best cosmetic results possible. Additionally, we must take into account the possibility of damage to structures such as nerves, salivary glands, and vessels. These areas must be carefully examined to minimize the chances of undetected damage, which can create long term problems.
Bone Injuries to the Maxillofacial Region (Fractures)
The primary goal in the treatment of all types of fractures is to “reduce and stabilize” – simply put, the goal is to return the bone to its proper position and keeping it there. When a person fractures their arm, an orthopedic doctor typically places a cast on the injured area to keep the bone in its proper position for healing. Since a cast cannot be applied to the bones of the face, we must use special techniques and materials to ensure sufficient support while the fractured bones heal. While treatment for your particular case will be determined by Dr. Martin and Dr. Appelblatt during examination, we will explain some common treatment methods here for reference:
One method of stabilization used for jaw fractures is called Intermaxillary Fixation – this is where surgical braces are placed around the teeth and then the braces are fixed together. This is often referred to as wiring the jaws together. For certain fractures of the upper and/or lower jaw, this is the best option, as it completely stabilizes the fractured area(s). Generally this period of stabilization lasts between 4 – 8 weeks depending on the type and severity of the fracture.
Another method of fracture stabilization is called Rigid Fixation. This method provides stabilization of the fractured area through the surgical placement of small titanium plates and screws.
Injuries To The Teeth & Surrounding Dental Structures
Injuries to the teeth are the most common type of facial trauma we see. Dental injuries often require the expertise of several dental specialists working together. Dr. Martin and Dr. Appelblatt are often the first specialists called in to treat the immediate injury. They help to stabilize the fractures in the supporting bone, suture any soft tissue injuries, and place implants or bone grafting in areas where teeth have been lost. Re-inserted or displaced teeth are typically stabilized by wiring or bonding the teeth together but will require further treatment from an endodontist and restorative dentist after the patient’s immediate injury is addressed.
In some trauma cases, permanent teeth are so badly damaged (or outright lost) and cannot be saved. Dental implants are typically the best option for replacing the missing teeth with fully-functional, natural looking and feeling teeth.