Maxillofacial Trauma

Oral and maxillofacial surgeons are specialists trained, skilled, and uniquely qualified to diagnose and treat oral and facial injuries. Dr. Bluhm, Dr. Dorsch, and Dr. Vandervort are on staff at INOVA Loudoun Hospital and provide emergency room coverage for facial injuries, which can include:

  • Avulsed (knocked out) teeth
  • Facial lacerations
  • Fractured facial bones (cheek, nose, or eye socket)
  • Intraoral lacerations
  • Fractured jaws (upper and lower jaw)

By their very nature, injuries to the face impart a high degree of emotional and physical trauma to patients. The science and art of treating facial injuries requires special training, including “hands-on” experience and an understanding of how treatment can influence the patient’s long-term appearance and function.

The Nature of Maxillofacial Trauma

Facial trauma can be caused by a number of things, including motor vehicle accidents, accidental falls, interpersonal violence, sports injuries, and work-related injuries. Types of facial injuries can range from merely injuries of the teeth to extremely severe injuries of the bones and skin of the face. Facial injuries are classified into one of three categories: soft tissue injuries (gums and skin), bony injuries (fractures), or injuries to special regions (such as the facial nerves, eyes, or the salivary glands).

Soft Tissue Injuries of the Maxillofacial Region

When soft tissue injuries, such as lacerations, occur on the face, our oral surgeons will repair them by “suturing.” In addition to the providing the treatment which will yield the most aesthetically pleasing result possible, care is taken to inspect for and treat injuries to structures such as salivary glands, facial nerves, and salivary ducts or outflow channels.

Bone Injuries of the Maxillofacial Region

Fractures that occur in the bones of the face are treated similarly to fractures that occur in other parts of the body. The specific form of the treatment will be determined by a number of factors, including the location of the fracture, how severe the fracture is, and the general health and age of the patient. When a leg or an arm is fractured, it is not uncommon for a “cast” to be applied to stabilize the bone and encourage proper healing. Because a cast cannot be placed on the face, other means of treatment have been developed to help stabilize facial fractures.

One of the available treatment options involves wiring the jaws together for certain kinds of fractures of the lower and/or upper jaw. However, other types of jaw fractures are best treated and stabilized by the surgically placing small “plates and screws” into the involved site. This technique often allows for proper healing and eliminates the necessity of having the jaws wired together for an extended period. The plates and screws technique is called “rigid fixation” of a fracture. The relatively recent development and use of “rigid fixation” has profoundly quickened the recovery period for many people and has allowed them to return to normal function faster than ever before.

The facial fracture treatment is accomplished in a predictable and thorough manner. Importantly, the victim’s facial appearance should be minimally affected. An attempt at accessing the facial bones using the fewest incisions necessary is always made. All of our necessary incisions are designed to be small and, whenever possible, are placed to “hide” the resultant scar.

Injuries to the Teeth and Surrounding Dental Structures

Isolated injuries to the teeth are actually quite common and can require the expertise and experience of several dental specialists. Oral and maxillofacial surgeons usually become involved if there is a fracture in the supporting bone or if the teeth that have been “knocked out” or displaced need to be replanted.  These types of injuries are treated by “splinting” (stabilizing by bonding or wiring teeth together). If a tooth is displaced, it should be placed in a cup of milk or in the patient’s own saliva. The sooner the tooth is re-inserted into the empty socket, the better chance it will survive and replant correctly. If a tooth is displaced, the patient should visit a dentist or oral surgeon as soon as possible. Do NOT attempt to “wipe the tooth off” because remnants of the ligament that attach the tooth to the jaw may still be on the tooth and are absolutely necessary to the success of replanting the tooth. Additional dental specialists such as endodontists (root canal specialists) and/or restorative dentists (who repair and rebuild fractured teeth) may also be involved in the process. If the injured teeth cannot be saved or repaired, dental implants are a natural-looking replacement for missing teeth.