Facial Traumatic Injuries and Reconstruction

Facial injuries are most often caused by motor vehicle accidents and assaults. These injuries can result in facial bleeding, swelling, bruising, lacerations, cuts, burns, and deformities. Computed tomography (CT) is the primary imaging method used to assess facial trauma because it provides detailed images of both bone and soft tissue. Severe or complex injuries may require facial reconstruction surgery, especially in children, where the procedure must account for the ongoing growth and development of facial features and the skull. 

Plastic surgery encompasses a wide range of procedures focused on restoring form, function, balance, and harmony to the body. When the body undergoes trauma, it’s important to restore some of that form and function. Common causes of trauma reconstruction include broken noses, amputations, work-related injuries, injuries to the face, head, and neck, extensive skin loss from infection or burns, and skin cancer removal. Some reconstructive surgical procedures require a combination of surgery, physical therapy, and emergency care. Recovery from burns, car accidents, amputations, and lacerations often occurs in stages. Once stable, patients undergo surgery and frequently follow up with physical or occupational therapy and trauma reconstruction. 

What is Facial Trauma?

Facial trauma refers to damage to the bones or soft tissues of the face caused by incidents such as motor vehicle accidents, assaults (including gunshots), sports injuries, falls, chemical exposures, thermal burns, or animal bites. The face is a complex area with numerous bones, blood vessels, nerves, muscles, and sensory organs. Untreated facial trauma can lead to permanent loss of functions like seeing, chewing, speaking, and swallowing, as well as disfigurement. Emergency doctors, plastic and reconstructive surgeons, and other practitioners work together to reduce the risk of permanent complications. 

Traumatic Injuries to the Face

Facial trauma can cause severe bleeding, swelling, bruising, and distortion of facial features. 

Facial Fractures

Facial fractures can affect any part of the face, impairing function or distorting appearance. Severe fractures can lead to cerebrospinal fluid leakage around the brain. A broken jaw can impact eating, chewing, speaking, and swallowing, while cracked or broken teeth may require dental restoration. Midface fractures, such as LeFort I, II, and III fractures, vary in severity and location, affecting areas from above the teeth to the upper jaw and eye sockets. Orbital fractures include orbital rim fractures and blowout fractures, which can lead to vision problems and pain. 

Facial Soft Tissue Injuries

These injuries may include torn skin or scalp, cuts and scrapes, burns (thermal or chemical), eye injuries, and nerve damage affecting facial movements and sensations. 

Emergency Treatment for Facial Injuries

Initial treatment for facial injuries from accidents, falls, burns, animal bites, or assaults occurs in the emergency department, where a full trauma evaluation is conducted. Medical staff work to control bleeding and swelling and assess the impact on the airway, brain, and vision. 

Diagnosing Facial Injuries

After a physical examination, CT scans are used to assess facial trauma, providing detailed images of bones, soft tissues, and blood vessels. Plastic and reconstructive surgeons may order additional imaging for surgical planning. 

Repairing Traumatic Facial Injuries

Patients with deep cuts, lacerations, or bone fractures are often referred to plastic and reconstructive surgeons. Effective communication between patients and surgeons is crucial for understanding surgical options, treatment plans, and expected outcomes. 

Goals of Facial Trauma Treatment

The primary goals are to restore normal facial functions such as focusing, blinking, smiling, chewing, speaking, and swallowing, while also optimizing appearance. Surgical decisions consider both functional outcomes and aesthetic results, with techniques drawn from experience in other types of facial surgeries. 

Repairing Soft Tissue Injuries to the Face

Treatment for soft tissue injuries may include microvascular reconstructive surgery to repair nerves and blood flow. 

Addressing Facial Trauma Affecting the Eyes 

Facial injuries can involve peripheral nerves affecting eye movement and sensation. Early documentation of neurological problems is essential to prevent complications like blindness. 

Repair and Reconstruction of Facial Bones

Surgical treatments may include resetting bones manually, open reduction surgery, jaw wiring, bone or skin grafts, and repairing facial bones with titanium hardware. 

Collaborating with Other Specialties

Plastic and reconstructive surgery teams often collaborate with ophthalmologists, neurosurgeons, dental experts, speech pathologists, and mental health practitioners to ensure comprehensive care and recovery from facial trauma. 

Pediatric Facial Trauma Patients

Facial trauma in children, though rare, requires careful and long-term monitoring to ensure proper growth and healing. Surgeons counsel patients and caregivers about the importance of follow-up to address any developmental impacts from the trauma. 

Dr. Boonipat has extensive training in facial trauma and bony reconstruction. 

FAQ: Facial Trauma

How Many Surgeries May Be Necessary?

Some traumatic injuries cannot be corrected with a single surgery and may require multiple procedures. For instance, burns and amputations often need several surgeries to restore acceptable form and function. The extent and number of surgeries will be determined in consultation with you and Dr. Boonipat. 

Can Trauma Surgery Be Performed on Scars?

Depending on the circumstances, some scars are thicker and more problematic than others. Certain types of severe scars may require surgery because they can become tight, interfere with mobility, or cause significant discomfort. 

When Should I Consider Trauma Surgery?

Some post-trauma surgeries, like tumor removal, can be extensive and create significant bony and soft tissue defects. These cases often require immediate reconstruction during the initial surgery to enhance the chances of successful wound repair, followed by several smaller staged surgeries.