Facial trauma is common. The main causes of facial trauma include sports injuries, motor vehicle accidents and interpersonal violence. If left untreated, facial trauma can result in permanent issues with facial appearance and function. The face contains a number of specialised structures, like the eye and nose, in addition to skin, muscles, nerves, bones and blood vessels. The severity of an injury is often determined by which structures are involved with the trauma. The bones of the face are delicate and so facial fractures are not uncommon.

A/Prof Damian Marucci performs different types of facial reconstructive surgery in Sydney to repair traumatic injuries and prevent permanent issues.

Nasal Bone Fractures

The nasal bones are the most commonly fractured facial bones. Usually, they are pushed over to one side, causing a nasal deviation. Sometimes the septum (the cartilage that runs down the middle of the nose, dividing it into two halves) can also be affected. The deformity of a broken nose can become permanent if the bones aren’t straightened within 10 days of the trauma. The procedure to straighten a broken nose is called a “closed reduction.” The “reduction” of the bones back into their normal position is called “closed” as no incisions are made in the skin.

If the nasal bones remain in a bad position, the only way to re-straighten the nose is through a rhinoplasty. This is a more significant surgical procedure, so it’s important to straighten the nasal bones before they set.

Zygoma (Cheekbone) Fractures

Zygomatic (cheekbone) fractures are common. The fracture of the cheekbone can lead to a loss of projection of the cheek, leading to a permanent facial asymmetry. There is a nerve that comes out near the zygoma bone called the infra-orbital nerve. This nerve is often bruised or crushed in zygomatic fractures, causing numbness of the cheek and upper lip. Also, the zygoma forms part of the floor of the orbit (i.e., eye socket). In severe zygomatic fractures, the orbital floor needs to be repaired.

Treating a zygomatic fracture usually involves an operation called an “open reduction and internal fixation.” The cheekbone is accessed by some carefully placed incisions, which leave scars that become hard to see over time. The bone is moved back into a good position and then held in place with fine plates and screws. The idea is that the plates and screws stay there forever. If they cause any problems, they can be removed at a later date.

Orbital Floor (Eye Socket) Fractures

The bone underneath the globe of the eye is very thin. When eye suffers direct trauma, this bone fractures downwards, rather than allow the globe to be squashed. Orbital floor fractures can be associated with damage to the eye itself. Sometime the muscles that move the eye can be bruised or trapped. The infra-orbital nerve is commonly affected in orbital floor fractures, causing numbness of the cheek and upper lip. Finally, severe orbital floor fractures can cause the eye to permanently look sunken in.

Some orbital floor fractures are mild enough that no treatment is needed. Others are more severe and need surgical treatment. Surgery involves a general anaesthetic and an incision in the lower eyelid. The orbital floor is then reconstructed, usually with a plate. The long-term results of orbital floor fractures are typically very good.

Le Fort Fractures

Le Fort fractures refer to complex fractures of the midface (between the eyes and the mouth) which can separate the upper jaw from the rest of the facial bones. These are severe fractures that always need surgery to re-align the bones and hold that realignment with plates and screws.

Mandible (Jawbone) Fractures

Mandible fractures can lead to permanent problems a patient’s bite unless accurate realignment is performed. Numbness of the lower lip is very common with mandibular fractures, as the nerve that supplies sensation to the lower lip travels through the bone. As a result, it is almost always bruised or damaged in mandible fractures.

Treatment of mandible fractures almost always involves surgery. Plates and screws are used to hold the jaw bones in a good position. Arch bars, which are like orthodontic braces, are used to align the bones during surgery and guide the patient into a normal bite in the weeks after surgery. Mostly, the incisions to access the bones are all made within the mouth, although sometimes incisions need to be made in the neck.

Consult with A/Prof Damian Marucci

Would you like to speak to a surgeon that specialises in facial reconstructive surgery? Sydney plastic surgeon Damian Marucci invites you to call or email our office and request a consultation.