Facial Trauma

Our colleagues in the Accident and Emergency Department usually refer this to us within the hospital but occasionally patients present to their general practitioner. These tend to be less dramatic and less obvious fractures, which are not always easy to diagnose.

Fracture of the zygoma (malar)

Majority are commonly the result of assault

PRESENTATION

Lateral subconjuctival haemorrhage

• Infra orbital anesthesia/paresthesia
• Diplopia
• Trismus or restricted mandibular movements
• Step derformities

Clinical Appearance of fractured right zygoma

Occasionally a patient with a history of a blow to the eye will present with only diplopia. This may be the only sign of a pure "blow-out " fracture of the orbital floor. These cases need referral for proper assessment as late enopthalmos and permanent diplopia can result if not treated.

Mandibular Fractures

The other commonly missed fracture is at the neck of the mandibular condyle Treatment depends on the radiographic appearance and the degree of displacement.

Fracture of the mandible in the premolar region

Facial fractures are treated by internal fixation using small bone plates which are not normally removed. This usually obviates the need for external fixation or intermaxillary fixation (wiring the jaws together). All patients are counselled about diet and oral hygiene and are reviewed regularly. Fixation lasts from 6-8 weeks and during this time it is unwise for patients to undertake in contact sports which might undermine fracture stability.

Soft tissue lacerations are usually sutured under local anaesthetic either in A & E or in our department. Skin lacerations are usually sutured with nylon and patients are advised to see their practice nurse 5 days post op for their removal.