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Facial trauma

Maxillofacial injury; Midface trauma; Facial injury; LeFort injuries

Facial trauma is an injury of the face. It may include the facial bones such as the upper jaw bone (maxilla).

Causes

Facial injuries can affect the upper jaw, lower jaw, cheek, nose, eye socket, or forehead. They may be caused by blunt force or be the result of a wound.

Common causes of injury to the face include:

• Car and motorcycle crashes
• Wounds
• Sports injuries
• Violence

Symptoms

Symptoms may include:

• Changes in feeling over the face
• Deformed or uneven face or facial bones
• Difficulty breathing through the nose due to swelling and bleeding
• Double vision
• Missing teeth
• Swelling or bruising around the eyes that may cause vision problems

Exams and Tests

The health care provider will perform a physical exam, which may show:

• Bleeding from the nose, eyes, or mouth
• Nasal blockage
• Breaks in the skin (lacerations)
• Bruising around the eyes or widening of the distance between the eyes, which may mean injury to the bones between the eye sockets
• Changes in vision or the movement of the eyes
• Improperly aligned upper and lower teeth

The following may suggest bone fractures:

• Abnormal feelings on the cheek
• Irregularities of the face that can be felt by touching
• Movement of the upper jaw when the head is still

A CT scan of the head and bones of the face may be done.

Treatment

Surgery is done if the injury prevents normal functioning or causes a major deformity.

The goal of treatment is to:

• Control bleeding
• Create a clear airway
• Treat the fracture and fix broken bone segments
• Prevent scars, if possible
• Prevent long-term double vision or sunken eyes or cheek bones
• Rule out other injuries

Treatment should be done as soon as possible if the person is stable and does not have a neck fracture.

Outlook (Prognosis)

Most people do very well with proper treatment. More surgery may be needed in 6 to 12 months to correct changes in appearance.

Possible Complications

Complications may include:

• Bleeding
• Uneven face
• Infection
• Brain and nervous system problems
• Numbness or weakness
• Loss of vision or double vision

When to Contact a Medical Professional

Go to the emergency room or call the local emergency number (such as 911) if you have a severe injury to your face.

Prevention

Wear seat belts while driving.

Use protective head gear when doing work or activities that could injure the face.

References

Kellman RM. Maxillofacial trauma. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 20.

Mayersak RJ. Facial trauma. In: Walls RM, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice. 10th ed. Philadelphia, PA: Elsevier; 2023:chap 34.

Nam AJ, Davidson EH, Manson PN. Assessment of the patient with traumatic facial injury. In: Dorafshar AH, Rodriguez ED, Manson PN, eds. Facial Trauma Surgery. Philadelphia, PA: Elsevier; 2020:chap 1.1.

Neligan PC, Buck DW, Facial injuries. In: Neligan PC, Buck DW, eds. Core Procedures in Plastic Surgery. 2nd ed. Philadelphia, PA: Elsevier; 2020:chap 9.

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Review Date: 7/1/2023  

Reviewed By: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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