Facial trauma refers to any injury to the face or upper jaw bone, including injuries to the skin, underlying skeleton (bone), neck, nose and sinuses, eye socket, teeth, or other parts of the mouth. Sometimes these types of injuries are called maxillofacial injuries. Facial trauma is often recognized by swelling, bruising, or cuts. Signs of broken bones include bruising around the eyes, widening of the distance between the eyes, movement of the upper jaw when the head is stabilized, and bleeding from the nose, mouth, or ear.
In the U.S., about three million people are treated in emergency departments for facial trauma injuries each year. Of pediatric patients, five percent have suffered facial fractures. In children under three-years-old, the primary cause of these fractures is falls. In children more than five-years-old, the primary cause for facial trauma is motor vehicle accidents. Fortunately, the correct use of seat belts, boosters, and car seats can dramatically reduce the risk of facial trauma in children.
Activities such as contact sports, cheerleading, gymnastics, and cycling put children at risk for facial injury. Proper supervision and appropriate protective gear, such as bicycle helmets, shin guards, helmets, etc., should always be used during these activities. But when accidents do happen, children’s facial injuries require special attention, as a child’s growth and development play big roles in treatment for facial trauma. One of the most important issues for a caregiver is to follow a physician’s treatment plan as closely as possible until your child is fully recovered.
Pediatric facial trauma differs from adult injury because children’s faces are not fully formed, and future growth will be a factor in how the child heals and recovers. Certain types of trauma may cause a delay in growth or further complicate recovery. Facial trauma can range from minor injury to disfigurement that could last a lifetime. The face is critical in communicating with others, so it is important to get the best treatment possible. Difficult cases require doctors or a team of doctors with special skills to perform a repair that will “grow” with your child.
New technology, such as advanced computed tomography (CT) scans that can provide three-dimensional anatomic detail, has improved physicians’ ability to evaluate and manage facial trauma. In some cases, immediate surgery is needed to realign fractures before they heal incorrectly. Other injuries will have better outcomes if repairs are done after cuts and swelling have improved. Research has shown that even when an injury does not require surgery, it is important to a child’s health and welfare to continue to follow up with a physician’s care.
Soft Tissue Injuries
Cuts, or lacerations, may occur on the soft tissue of the face. In combination with stitching the wound, an ENT (ear, nose, and throat) specialist, or otolaryngologist, or treating physician should inspect and treat any injures to the facial nerves, glands, or ducts. In younger children, many lacerations require sedation or general anesthesia to achieve the best repair.
When facial bone fractures occur, the treatment is similar to that of a fracture in other parts of the body. Some injuries may not need treatment, and others may require stabilization and repair using wires, plates, and screws. Factors influencing these treatment decisions include the location of the fracture, the severity of the fracture, and the age and general health of the patient. It is important to restore appearance and function as accurately as possible.
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Because of the specific needs of dental structures in the mouth, certain actions and precautions should be taken if a child has received an injury to their teeth or surrounding dental structures.
If a tooth is knocked out, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better the chance it will survive, so the patient should see a dentist or oral surgeon as soon as possible. Never attempt to “wipe off” the tooth because remnants of the ligament, which hold the tooth in the jaw, are attached and vital to the success of replanting the tooth.
Stewart MG, Chen AY. Factors predictive of poor compliance with follow-up after Facial trauma: A prospective study. Otolaryngol Head Neck Surg 1997: 117:72-75
Kim MK, Buchman R, Szeremeta. Penetrating neck trauma in children: An urban hospital’s experience. Otolaryngoly–Head Neck Surgery 2000: 123: 439-43