Facial injuries are common and may range from simple cuts to severe trauma with tissue loss, fractures and devitalization. While it may be desirable, it is no practical for all facial injuries to be seen and treated by a plastic surgeon in emergency. However, once properly cleaned and covered with sterile dressing, such injuries can, if so desired, seen and treated by the plastic surgeon on the next day.
Complex injuries however need the expertise of plastic surgeons. Such injuries cause tremendous swelling which may be alarming. In high impact injuries we have to consider and rule out brain and eye injury as well. Now-a-days CT scans may be obtained to reveal more accurate details of the injury. Emergency doctors will often be the first contact person to manage them initially; he/she will then orchestrate the other doctors to give their expertise if needed.
Comprehensive management of such patients may involve multiple specialists such as dentists, eye surgeons, ENT surgeons and Neurosurgeons. In some hospitals, it is usual for such cases to be treated by maxillofacial surgeons [they usually come from dental background and have specialization in facial surgery]. Which of these two specialists is called depends on local availability and arrangements. Fractures of the jaws, cheek bone [Zygoma], nose, forehead and orbits are treated by using modern osteosynthesis methods where applicable. Titanium mini-plates and screws assure secure anatomical fixation and early return to activity.
Orbit blow-out fractures:
A special area of facial trauma is orbit fracture; where the skills and knowledge of a facial plastic surgeon and an ophthalmologist are needed. An orbital blow-out fracture is one where the floor of the eye socket is blown away resulting in a deficiency in the floor of the orbit. The eye may appear quite normal initially and usually functions well. But after a few days the eye will sink in. If not recognized and corrected in time, late results are disappointing. The best way to find this peculiar fracture is by a CT scan
It is important to suspect orbit blow out fracture if any of the following is found after injury to that area:
- Restriction of eye movement in different directions
- Double vision
- Numbness of the cheek immediately below the eye, often with numbness of upper lip on that side
- Sunken appearance of the eye
- Associated nasal bleed.
Minor cases are treated conservatively. In selected cases, surgery is needed to rebuild the floor and elevate the eye. The floor is repaired using special titanium plates taking great care with the nerves and structures of the orbit.