Blunt or penetrating trauma can cause injury to the midface region, which includes the upper jaw (maxilla). Common causes of facial injury include:

• Automobile accidents
• Violence
• Penetrating injuries

Findings with trauma in this region include:

• Difficulty breathing through the nose due to swelling and bleeding in the nasal region.
• Changes in sensation and feeling over the face
• Swelling around the eyes may cause limitations in vision.
• Double vision
• Missing teeth

On physical exam:

• Lacerations (breaks in the skin) are often seen.
• Bruising around the eyes and/or widening of the distance between the eyes may indicate injury to the bones between the eye sockets.
• When the upper jaw moves with the head stabilized, there may be a fracture in this area.
• Abnormal sensations on the cheek and irregularities that can be felt on the facial region can indicate fractures.
• The physical exam is often complemented by a CT scan of the head.

When the patient is unable to perform any normal function, or a substantial cosmetic deformity occurs, the treatment is usually surgical. Goals include:

• Establish a clear airway.
• Control bleeding.
• Treat the fracture.
• Rule out other injuries.
• Fix broken bone segments with titanium plates and screws.
• Use existing lacerations and incisions in the mouth and around the eye and scalp during surgery to minimize scarring.
• Treatment should be immediate, as long as the patient is stable and cleared of all life-threatening injuries and the neck has been cleared of fractures.

Patients generally do very well with proper pre-operative workup and planning. The patient should be forewarned that they will most likely look different from their pre- injury state and that additional surgeries may be necessary 6-12 months later.

General complications include, but are not limited to:

• Bleeding
• Infection
• Neurologic complications
• Facial asymmetry

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

Wear seat belts and use protective head gear when appropriate. Avoid triggering potentially violent confrontations with other people.