What Are Different Types of Facial Injuries?

Oral and maxillofacial injuries are usually caused by work injuries, sports injuries, traffic accidents, and accidental injuries in life. The blood circulation in the maxillofacial region is rich, and the upper part connects the brain and the lower part is the beginning of the respiratory tract and digestive tract. There are many maxillofacial bones and cavities, with teeth attached to the jawbone, and the mouth contains the tongue; the facial muscles and facial nerves; and the temporomandibular joint and salivary glands; they exercise expression, language, chewing, swallowing and breathing And other functions.

Maxillofacial injury

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Oral and maxillofacial injuries are usually caused by work injuries, sports injuries, traffic accidents, and accidental injuries in life. The blood circulation in the maxillofacial region is rich, and the upper part connects the brain and the lower part is the beginning of the respiratory tract and digestive tract. There are many maxillofacial bones and cavities, with teeth attached to the jawbone, and the mouth contains the tongue; the facial muscles and facial nerves; and the temporomandibular joint and salivary glands; they exercise expression, language, chewing, swallowing, and breathing And other functions.

TCM disease name

Maxillofacial injury

Common locations

Floor of mouth, base of tongue, jaw

Common causes

accidental damage

Common symptoms

Edema

Oral and maxillofacial injuries are usually caused by work injuries, sports injuries, traffic accidents, and accidental injuries in life. The blood circulation in the maxillofacial region is rich, and the upper part connects the brain and the lower part is the beginning of the respiratory tract and digestive tract. There are many maxillofacial bones and cavities, with teeth attached to the jawbone, and the mouth contains the tongue; the facial muscles and facial nerves; and the temporomandibular joint and salivary glands; they exercise expression, language, chewing, swallowing, and breathing And other functions.

1. Rich blood circulation: more bleeding after injury, easy to form hematoma; tissue edema response is fast and heavy, such as damage to the bottom of the mouth, root of tongue, submandibular and other parts, can affect the patency of the airway due to edema, hematoma compression, and even cause asphyxia. On the other hand, because the blood is abundant, the tissue has a strong ability to resist infection and regeneration, and the wound is easy to heal.

2. Maxillofacial injuries are often accompanied by dental injuries: crushed teeth can also splash into adjacent tissues, causing "secondary shrapnel injuries", and can bring the stones and bacteria attached to the teeth into deep tissues, causing windows infection. Dental caries on the jaw fracture line can sometimes cause bone stump infections, affecting fracture healing. On the other hand, the displacement of the dentition or the disorder of the occlusal relationship is one of the most important signs for the diagnosis of jaw fracture. In the treatment of tooth and alveolar bone or jaw fracture, it is often necessary to use teeth or dentition as the abutment and fixation, which is an important basis for traction fixation of the jaw.

3. Complicated craniocerebral injury: including concussion, brain contusion, intracranial hematoma, and skull base fracture. The main clinical feature is a history of coma after injury. Fractures of the skull base may be accompanied by cerebrospinal fluid flowing from the nostrils or external auditory meatus.

4. Sometimes with a neck injury: the maxillofacial region and the neck are where the large blood vessels and cervical spine are located. Mandibular injuries are prone to neck injuries. Pay attention to neck hematomas, cervical spine injuries, or high paraplegia. When blunt neck injuries to large neck blood vessels, carotid aneurysms, pseudoaneurysms, and arterial and venous fistulas can sometimes form at advanced stages.

5. Prone to suffocation: At the time of injury, breathing or suffocation may be affected due to tissue displacement, swelling and fall of the tongue, clogging of blood clots and secretions.

6. Affecting eating and oral hygiene: After injury or when treatment requires intermaxillary traction, mouth opening, chewing, speech or swallowing functions may be affected, preventing normal eating.

7. Prone to infection: oral cavity, nasal cavity, sinuses, and orbits are common in the oral cavity, maxillofacial sinus cavity, and so on. There are a large number of bacteria in these sinus cavities, which are susceptible to infection if they are the same as the wounds.

8. May be accompanied by other anatomical damage: oral and maxillofacial distribution of salivary glands, facial nerves and trigeminal nerves, such as damage to the parotid gland can cause salivary fistula; if the facial nerve is damaged, facial paralysis can occur; while trigeminal nerve injury can occur in Numbness appears in the corresponding distribution area.

9. Facial deformities: After the maxillofacial injury, there are often different degrees of facial deformities, which increase the mental and psychological burden on the injured.

Prevention of suffocation

2. Hemostasis and anti-shock

3. First aid with head injury

4. Prevent infection

5. Bandaging and Evacuation

After jaw fracture, it is mainly reset and fixed. An important sign of jaw fracture reduction is to restore the normal occlusal relationship of the maxillary teeth, that is, the extensive contact relationship of the teeth. Otherwise it will affect the recovery of chewing function after fracture healing. There are three common reset methods:

1. Manual reduction: In the early stage of jaw fracture, the fracture segment is relatively active, and the displaced fracture segment can be returned to the normal position by hand.

2. Traction reduction: After a long period of jaw fracture (more than three weeks in the maxilla and more than four weeks in the mandible), some fibrous tissue has healed at the fracture, and manual reduction is not successful. Traction reduction can be used. Mandibular fractures often use intermaxillary traction, which is to place a segmented dental arch splint on the displaced fractured section of the mandible, and then use a small rubber band to elastically traction between it and the dental arch splint of the upper jaw to gradually return to normal. Bite relationship. After a maxillary fracture, if the fractured section is shifted backwards, a dental arch splint can be placed on the maxillary dentition, a plaster cap with a metal bracket is made on the head, and elastic traction is performed between the dental arch splint and the metal bracket to make the upper jaw The fractured bone is reduced forward. When larger traction is required, it can also be used for horizontal gravity traction.

Fixation of jaw fractures after reduction is an important part of treatment. Commonly used fixation methods include single jaw arch splint fixation, intermaxillary fixation, intermaxillary ligation fixation, miniplate or microplate fixation, cranio-maxillary fixation, and other methods include per jaw fixation. Method, pressurized steel plate fixing method, etc.

1. Single jaw dental arch splint fixation method: It uses aluminum wire with a diameter of 2 mm or a finished dental arch splint with a shape of the dental arch, and then uses a thin metal ligation wire to pass through the interdental space to ligate the dental arch splint to the fracture. Part or all of the teeth on both sides of the line to fix the fractured segment. This method is suitable for fractures without significant displacement, such as the following median linear fractures of the jaw condyle and local fractures of the alveolar process.

The sacrum and sacral arch are relatively prominent parts of the face, which are prone to fracture due to impact. The sacrum is related to the maxilla, frontal, sphenoid, and temporal bones. Among them, the maxillary surface is the largest. Therefore, sacrum fractures are often accompanied by maxilla fractures. The temporal process of the patella and the condyle of the temporal bone connect to form the zygomatic arch, which is thinner and narrower and more prone to fracture.

1. Diagnosis of patella and zygomatic arch fractures can be clearly diagnosed according to the history of injury, clinical characteristics and X-ray examination.

Palpation fractures may have tenderness, collapse and displacement, and there may be steps formed at the zygomatic frontal suture, the zygomatic maxillary suture junction, and the infraorbital margin. If palpation is made from inside the mouth along the vestibular sulcus and upwards and backwards, you can check whether the gap between the sacrum, maxilla, and coracoid process has become smaller. These all help to diagnose the patella fracture.

X-ray examination often takes the nasal condyle and zygomatic arch. In the nasal condyle X-ray, not only fractures of the sacrum and sacral arch can be seen, but also the orbit, maxillary sinus and suborbital foramen can be observed for abnormalities. The zygomatic arch position can clearly show the zygomatic arch fracture and displacement.

Generally, it can be divided into zygomatic fractures, zygomatic arch fractures, zygomatic and zygomatic arch fractures, and zygomatic maxillary complex fractures. The zygomatic arch fractures can be divided into double-line and triple-line fractures. Knight and North proposed a type 6 classification:

No displacement fracture.

zygomatic arch fracture.

Metatarsal body fractures are shifted inward without transposition.

Internally displaced metatarsal body fractures: counterclockwise to the right or clockwise or to the midline by rotating the X-ray film showing that the inferior orbital margin descends from the forehead to the medial side.

Outward transposition of zygomatic body fractures. The left side is rotated clockwise to the right and counterclockwise to the right or away from the midline. Rotating the X-ray film shows that the inferior orbital edge is upward and the forehead process is shifted to the outside.

Complex fracture.

It is generally believed that fractures do not require stabilization after reduction; fractures require instability after reduction.

Maxillofacial injury symptoms and signs

The most common symptoms are local pain, nosebleeds, collapse or deflection of the upper bridge of the nose, and subcutaneous bruising. After a few hours, the soft tissue of the nose swells, and subcutaneous emphysema can occur after blowing the nose, and there is a twisting sensation, and the deformity is covered, but the tenderness is obvious. The nasal septum cartilage deviates from the midline and the leading edge protrudes to one side of the nasal cavity. If a submucosal hematoma appears, the nasal septum swells to one or both sides. Such as secondary infections can cause nasal septum abscesses, and cartilage necrosis can cause saddle nose deformities.

Clinical manifestations of maxillofacial injury

1. The types of displaced and deformed nasal bone fractures depend on the nature, direction, and size of the violence. If the striking force comes from the side, one side of the nasal bone may fracture and displace into the nasal cavity, causing a bent nose deformity; if the striking force is greater, the bilateral nasal bone together with the nasal septum may be fractured at the same time, causing the entire nasal bone to be displaced to the opposite side Nasal deformity is more obvious; if external force directly hits the root of the nose, a transverse fracture can occur, separating the nasal bone from the frontal bone, and the fracture piece is shifted into the nasal cavity. Nasal septum and ethmoid bone damage may occur concurrently; if the nasal bone is hit by violence in front, comminuted fractures and no collapse displacement may occur, and saddle nose deformities may occur.

2. Nasal hemorrhage The nasal mucosa is closely connected with the periosteum, and nasal bone fractures are often accompanied by nasal mucosa tearing and bleeding.

3. Nasal Respiratory Disorder After nasal bone fracture, nasal respiratory disorder may occur due to fractured piece displacement, nasal mucosal edema, nasal septum hematoma, and blood clot accumulation.

4. Eyelid ecchymosis After fracture of the nasal bone, ecchymosis may occur due to bleeding from the tissues to the bilateral eyelids and under the combined membrane.

5. Cerebrospinal fluid Nasal leakage can occur when a nasal bone fracture is accompanied by ethmoidal injury or anterior cranial fossa fracture. In the early stage, there is extravasation of cerebrospinal fluid mixed with blood, after which the blood decreases or only clear cerebrospinal fluid flows out.

Maxillofacial injury treatment plan

Hemostasis, debridement, suture prevention and infection prevention are the same as general trauma.

1. Fracture reduction should be performed as early as possible to avoid future dislocation healing and difficulty in reduction. First anaesthetize the upper surface of the affected side of the nasal cavity, use the reducer to reach the depression of the nasal bone, and raise it under the nasal bone. At this time, the "click" sound that occurs when the nasal bone is reset is often heard. The depth of the reduction instrument's end extending into the nasal cavity should not exceed the internal condylar line on both sides, so as not to damage the sieve plate. If the nasal septum cartilage is dislocated, it should be reset simultaneously. After the reduction, the nasal cavity needs to be stuffed to support and stop bleeding. Then take analgesics and prevent infections.

2. Treatment of nasal septum hematomas and abscesses The blood clots in the hematomas are difficult to absorb and need to be removed early to avoid cartilage necrosis. The incision should be large enough to make an L-shaped incision, drain it thoroughly, and stuff the nasal cavity after surgery to prevent recurrence, and use anti-inflammatory drugs to control the infection. ^[1]