Facial Trauma

This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (25/10/2020)

Original Editor - User: Wendy Walker

Top Contributors - Wendy Walker  

One Page Owner - Wendy Walker as part of the One Page Project

Introduction

Trauma to the face and head can be caused by a number of events: explosions, gunshot, road traffic accidents, falling masonry, flying glass, sports injuries, and blunt force trauma.

There can be bony damage - fractures can occur in any of the bones of the head and face, but are particularly common in the mandible and nose - and also soft tissue injury. CT scanning is essential for diagnosis as this shows fractures of facial bones more reliably than plain X-ray, and also shows soft tissue injury[1]. Facial and head trauma can also cause damage to the Facial Nerve or the Trigeminal Nerve.

In addition there may be direct damage to the eye.

It is important to be aware that a number of patients who suffer trauma to the upper regions of the face also suffer from brain injury[2], and some have co-existing cervical spine injury[2].

Initial repair following serious facial trauma is performed by surgeons; fractured bones will be plated or wired, skin and soft tissue lacerations will be stitched, large areas of severe soft tissue damage may require grafting[3][3][4].

The physiotherapy rehabilitation of these patients is thus largely post operative rehabilitation.

Epidemiology

The main causes of facial trauma is road traffic accidents (RTAs), followed by falls, assaults and sports injuries[5]. Many studies from different countries show that world-wide the prevalence of facial trauma is considerably higher in men than women[6][7][8], It is clear that the causes of maxillofacial injuries vary from one country to another, and even within the same country as a result of environmental, socioeconomic and cultural factors[9].

Developing Countries

In developing countries which have a high usage of motorised vehicles, RTAs account for up to 93% of facial injuries[6], with a high proportion of these involving motorcycles. One study reports that as many as 50 to 70% of RTA survivors suffer from facial trauma. In countries where motorcycles are a major form of transport, such as Malaysia, RTAs involving motorcycles biggest single cause of facial trauma[10].

Developed Countries

One large study in Austria[7] found that the causes of maxillofacial injury were: in 38% of cases, an activity of daily life, in 31% sports, in 12% violence, 12% RTA, 5% work accidents, 2% other causes.

Initial Stages

The face has a very rich blood supply, so healing is usually rapid.

Soft Tissue Injury

In areas of thin skin (eg. the eyelids) sutures can normally be removed after just 3-4 days, and elsewhere on the face they are often removed after 6 days[11]. Sutures in cartilage, for example the ear or the nose, are often left in situ for 10-14 days.

Bony Injury

Surgical repair is often required for bony injury, which may involve wiring or plating, or more substantial surgical techniques to rebuild the damaged bone, such as bone grafting.[2]

Surgical Interventions

Maxillary Repair

Maxillary Reconstruction

Later Stages

Once the surgical repair techniques have been completed, the body continues the healing, producing scar tissue.

The proliferation phase of scar tissue lasts for 2-3 weeks, and it is in this phase that the majority of the scar tissue is laid down.

This is followed by the remodelling phase, when the scar tissue continues to rebuild and remodel.

Please see the Soft Tissue Healing page for more details on scar tissue formation.

Physiotherapy following Facial Trauma

Rehabilitation should begin as soon as the surgeons permit it.

The aim of physiotherapy is to restore as much facial range of movement as possible, which will result in restoration of facial function.

Clinical Presentation

Any of the following may occur, often several in combination:

  • Reduced facial range of movement
  • Inability to close the eye
  • Inability to move the lips eg. into a smile, pucker
  • Inability to bite or chew
  • Asymmetry of the facial structures
  • Difficulties keeping food in the mouth when eating
  • Difficulties forming a lip seal on a vessel when drinking
  • Dry eye
  • Dry mouth
  • Reduction in non-verbal communication through facial expression

Rehabilitation

Manual techniques to the soft tissues, and when required to the Temporomandibular Joint, are the main physiotherapeutic modalities utilised.

Temporomandibular Joint Rehabilitation
  • Active exercises to increase TMJ range of movement. These should include all TMJ movements:
Rehabilitation for Facial Lacerations
Nerve Injury Rehabilitation - Trigeminal Nerve
Nerve Injury Rehabilitation - Facial Nerve

There are a series of pages on this topic; the main one to consult is the Facial Palsy page.

References

  1. Jordan JR, Calhoun KH (2006). "Management of soft tissue trauma and auricular trauma". In Bailey BJ, Johnson JT, Newlands SD, et al. (eds.). Head & Neck Surgery: Otolaryngology. Hagerstwon, MD: Lippincott Williams & Wilkins. pp. 935–36.
  2. 2.0 2.1 2.2 Perry M (March 2008). "Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 1: dilemmas in the management of the multiply injured patient with coexisting facial injuries". International Journal of Oral and Maxillofacial Surgery37 (3): 209–14
  3. 3.0 3.1 Aveta A, Casati P. Soft tissue injuries of the face: early aesthetic reconstruction in polytrauma patients.  Ann Ital Chir. 2008;79:415–417
  4. James D. Kretlow, Aisha J. McKnight, Shayan A. Izaddoost. "Facial Soft Tissue Trauma" Semin Plast Surg. 2010 Nov; 24(4): 348–356
  5. Wood E, Freer T. Incidence and Aetiology of Facial Injuries Resulting from Motor Vehicle Accidents in Queensland for a Three‐year Period.  Aus Dental J. 2001;46:284–8
  6. 6.0 6.1 Mohanavalli Singaram, Sree Vijayabala G, Rajesh Kumar Udhayakumar. Prevalence, pattern, etiology, and management of maxillofacial trauma in a developing country: a retrospective study. J Korean Assoc Oral Maxillofac Surg. 2016 Aug; 42(4): 174–181.
  7. 7.0 7.1 Robert Gassner 1, Tarkan Tuli, Oliver Hächl, Ansgar Rudisch, Hanno Ulmer. Cranio-maxillofacial trauma: a 10 year review of 9,543 cases with 21,067 injuries. . 2003 Feb;31(1):51-61.
  8. Schneider D, Kämmerer PW, Schon G, Dinu C, Radloff S, Bschorer R (2015) Etiology and injury patterns of maxillofacial fractures from the years 2010 to 2013 in Mecklenburg-Western Pomerania, Germany: a retrospective study of 409 patients. J Craniomaxillofac Surg 43:1948–1951.
  9. Einy S, Abdel Rahman N, Siman-Tov M, Aizenbud D, Peleg K (2016) Maxillofacial trauma following road accidents and falls. J Craniofac Surg 27:857–861.
  10. Maher M. Abosadegh, Norkhafizah Saddki, Badr Al-Tayar, and Shaifulizan Ab. Rahman. Epidemiology of Maxillofacial Fractures at a Teaching Hospital in Malaysia: A Retrospective Study BioMed Research International / 2019 / Research Article | Open Access Volume 2019 |Article ID 9024763
  11. Ardeshirpour F, Shaye DA, Hilger PA. Improving posttraumatic facial scars. Otolaryngol Clin North Am. 2013 Oct. 46(5):867-8