Maxillofacial injuries refer to combination injuries of the oral and facial bones. These injuries are complicated, and multi-speciality involvement may be needed. Maxillofacial injuries can involve the skin and soft tissue damage as well as facial bone fractures. This may require a high degree of care and excellent reconstructive surgeries.
Acute and long-term psychological problems can result from maxillofacial trauma and disfigurement. This may cause severe depression in the patient.
Injuries to the face and facial bones result from both sports activities and accidents and intentional violence. Major injuries in the past were as a result of road traffic accidents, but the compulsory wearing of seat belts, car airbags, head restraints and laminated windscreens have reduced all of these to a large extent.
However, the reduction in damage from this source has been almost matched by the increase in deliberate injury from physical violence.
WHAT ARE THE EFFECTS ON BODY:
The mouth and nasal passages are the upper airways, and the fractures of the facial skeleton may increase immediate or delayed respiratory obstruction. Immediate respiratory obstruction may happen due to inhalation of tooth fragments, accumulation of blood and secretions, and losing control of the tongue in the unconscious or semiconscious patient.
WHAT IS DONE AFTER INJURY:
Extensive investigations are done. All the blood tests are done, and X-rays are taken because sometimes only blood tests may not show clear readings. CT scans are usually much more accurate.
WHAT ARE FACIAL FRACTURES:
The maxillofacial region is divided into three parts:
- The upper face –Frontal bone and frontal sinus.
- The midface – Nasal, ethmoid, zygomatic and maxillary bones.
- The lower face – the mandible.
- Mandibles fracture more than zygoma and maxilla .maxilla bone fractures are again divided according to a medical classification called LE FORT classification.
The treatment for this fracture is again a different way by placing plates as shown but this is for the bone to become normal but the skin over this has an entirely different way to get replaced or to be healed. This is either grafted or transposed which means taking the skin from a particular part of the body and placing it so that it looks normal.
Soft-tissue injuries Facial soft tissues have an excellent blood supply and heal well. The tissues should be well cleaned and scrubbed if any dirt remains it may cause tattooing and enlargement of tissue. Many lacerations which are deep cuts may be closed using local anaesthesia just in and around the area of injury, injecting into the edges of the wound.Tissue sufficiently traumatised to have lost its blood supply would be removed, and the edge to which it is to be stitched with is appropriately cut and trimmed to fit as appropriate without making it look unnatural.
Great care is taken to replace tissues very accurately, particularly in cosmetically important areas such as the border of the lips, the eyelids and nasal borders. Securing the bleeding points is essential. Muscles and underlying layers should be brought together so that the edges of the wound lie within their final position.
Then fine sutures are used to bring the wound edges together. All stitches are placed to avoid compromising the blood supply of the tips of small flaps. Vacuum drains are used in areas of concern over dead space beneath the wounds. This is done to remove the blood that gets accumulated in the spaces in the face that cause swelling. The deep cuts are covered by antibiotic ointment and are replaced two to three times a day. This prevents the sutures from causing scarring of the skin. The sutures are usually removed on the third day.
The facial nerve is the main nerve of the face that helps in tear production, facial expression control. Puffing the cheek and other facial functions injury to this facial nerve may occur in the depth of a facial wound. If this is suspected, a primary repair will be attempted, notably where clinical signs suggest that a primary division is involved. Deep cuts of the facial tissues may be sutured in the normal way avoiding any tendency to displacement (movement of tissue from normal place). Antibiotics are recommended.