OVERVIEW

What is maxillofacial fracture?

Fracture refers to the breaking of bones. When one or more bones in the skull or face break, it is called a maxillofacial fracture. The jawbone forms the upper and lower parts of the oral cavity, including the maxilla and mandible.

Its adjacent structures include: the frontal bone (covering the visible front part of the skull, forehead, eyebrows, and upper half of the eye sockets), zygomatic bone (including the visible zygomatic arch), nasal bone, etc.

In trauma cases, isolated fractures of the maxilla or mandible are rare, often occurring alongside fractures of other facial bones or even multiple bones throughout the body. Treatment options include conservative management or surgery depending on severity, with generally favorable prognosis.

SYMPTOMS

What are the common manifestations of maxillofacial fractures?

• Basic symptoms of trauma: Local swelling, bleeding, pain, dysfunction (e.g., difficulty opening the mouth if the chin is injured, numbness of the lower lip due to nerve conduction impairment), local deformity, abnormal movement (e.g., segmented movement of the chin), etc.

• The maxillofacial region connects the skull above and the neck below and contains various bones with different functions. Fracture manifestations are complex and can be roughly categorized by the affected area:

• Bone damage: The most common is local maxillofacial bone loss, affecting facial appearance. Bone defects may also occur, with exposed contents or even adjacent skull base fractures, leading to cerebrospinal fluid leakage or brain injury.

• Nerve damage: The facial nerve runs through a narrow canal and is easily injured during fractures, resulting in symptoms such as abnormal facial sensation, loss of corneal sensation or blink reflex, weakened or lost jaw movement, shallow forehead wrinkles, or inability to blink or puff cheeks.

• Vascular damage: Local hematoma or severe bleeding may form. If a major artery is injured, immediate hemostasis is required to prevent hemorrhagic shock. Maxillary fractures often involve orbital and periorbital bleeding, causing "raccoon eyes" (periorbital bruising), eyelid or subconjunctival hemorrhage (resembling pink eye), and diplopia (double vision).

• Accessory organ damage: Such as lacerations to periorbital or perioral muscles, facial skin tears, leading to permanent scarring.

Where do maxillofacial fractures commonly occur?

Among maxillofacial fractures, the lower face (e.g., chin) is the most frequently affected, followed by the midface. Maxillofacial trauma often involves the skull.

What are the complications of maxillofacial fractures?

Since the maxillofacial region connects the skull and neck and is often caused by high-impact injuries like traffic accidents, it usually involves multiple injuries. Besides primary fractures causing facial deformities, eye injuries, oral or temporomandibular joint damage, etc., craniocerebral injuries are common.

Other complications include limb injuries, chest trauma, spinal damage, and potentially life-threatening conditions such as cerebral hemorrhage, brain herniation, or thoracic injuries (e.g., hemothorax, pneumomediastinum).

CAUSES

What are the common causes of maxillofacial fractures?

The oral and maxillofacial region is an exposed part of the body, making injuries to this area relatively common both in wartime and peacetime.

In daily life, mild maxillofacial fractures are often caused by sports injuries, while severe fractures typically result from traffic accidents, falls from heights, blast injuries, or severe interpersonal violence. Among these, traffic accidents account for the highest proportion.

Who is most susceptible to maxillofacial fractures?

Maxillofacial injuries are most common in young adults aged 20–29, followed by children. Males are more frequently affected than females.

DIAGNOSIS

How to diagnose maxillofacial fractures?

Maxillofacial fractures are generally diagnosed based on medical history combined with clinical signs or examination results.

• First, the patient has a clear history of external force injury (such as traffic accidents, falls, violence, or blunt trauma to the face);

• Second, damage to the maxillofacial area (such as local deformity, persistent bleeding, tissue defects with exposed contents, changes in vision or hearing, or altered consciousness) combined with maxillofacial imaging (CT or X-ray).

What tests are needed when a maxillofacial fracture is highly suspected?

Generally, CT or X-ray examinations are required. Both are used to determine whether there is a discontinuity in the bone (fracture) or changes in spatial structure (displacement).

However, X-rays have lower clarity and accuracy, and they display overlapping images of multiple maxillofacial bone structures, making them less accurate than CT scans.

With advancements in medical equipment, CT scans now offer two-dimensional and three-dimensional options. Three-dimensional CT can reconstruct images in a stereoscopic manner, making it more suitable for diagnosing complex midface comminuted fractures.

TREATMENT

Which department should I visit for maxillofacial fractures?

• When accidental injuries occur suddenly, life safety should be prioritized first. If the patient's vital signs are unstable (e.g., the patient cannot respond to your calls or shows no reaction to tapping) or the injury is too severe to move, call 120 immediately. Provide the exact address or nearby recognizable landmarks, the nature of the injury, and the patient's condition. If possible, send someone to meet the rescuers at the nearest intersection.

• Those remaining at the scene should provide proper care for the patient:

• If the patient has continuous bleeding, use clean, lint-free, non-decorative clothing or fabric to apply sustained pressure to the injured area for at least 5–10 minutes (but if the bleeding comes from the nasal cavity or ear canal, avoid wiping it before the doctor arrives to prevent potential cerebrospinal fluid leakage).

• If the patient has dentures or is unconscious, remove the dentures to prevent choking. Turn the patient's head to one side to avoid suffocation from oral/nasal bleeding or vomit.

• If there is tissue loss, preserve the severed part in a clean container for emergency personnel. If the injury is minor and the patient is stable enough to move, go to the nearest emergency department for X-ray or CT scans. After diagnosis, the patient may be referred to specialized departments such as maxillofacial surgery, otolaryngology, oral surgery, or cosmetic surgery for further treatment.

How is maxillofacial fracture treated?

• Non-surgical treatment: Dental arch splint intermaxillary traction, intermaxillary traction with screws, etc.

• Surgical treatment: Rigid internal fixation for maxillofacial fractures. With technological advancements, internal fixation materials continue to improve. Minimally invasive techniques, which cause less trauma, reduce pain, and minimize facial impact, are increasingly used in clinical practice.

Is hospitalization required for maxillofacial fractures?

For minor maxillofacial fractures that do not require surgery, hospitalization may not be necessary. However, severe cases must be treated in a hospital.

What are the common risks of surgical treatment for maxillofacial fractures?

• First, anesthesia risks.

• Second, due to the rich vascular supply and complex structure of the maxillofacial region, there is a risk of bleeding or suffocation during or after surgery. Areas like the sinuses, which connect to the external environment, also pose infection risks post-surgery.

• Postoperative scar formation may lead to facial deformities or affect jaw movement and function.

Can maxillofacial fractures be completely cured?

If there is no bone displacement or damage to vital organ functions, full recovery is possible under the guidance of a specialist.

DIET & LIFESTYLE

What should patients with maxillofacial fractures pay attention to in their diet?

• During hospitalization, especially before surgical treatment, patients should be given a high-protein, high-vitamin, easily digestible liquid diet to improve the body's tolerance to surgery. Options include pure milk, fresh soy milk, egg soup, mixed vegetable soup, meat broth, etc. Meals should be small and frequent, eaten slowly to avoid choking, and the food temperature should not be too high, with no spicy flavors. Families with financial means can consult the hospital's professional nutrition department to prepare specialized nutritional solutions based on the patient's height, weight, and nutritional needs.

• In the early postoperative period, the diet should be light, and oral hygiene must be maintained by rinsing after each meal. Postoperative foods should also be nutrient-rich, including fruits and vegetables high in vitamins (such as fish oil, carrots, tomatoes, and jujubes) and trace elements, as well as high-calorie foods rich in collagen, zinc, and calcium (such as fungus, seaweed, sesame paste, and dairy products). Depending on the patient's recovery, the food texture should gradually transition from liquid (soups) to thick liquid (meat puree, fruit puree, pastes), then to semi-liquid, soft, and finally regular food.

• Generally, after 2 weeks post-surgery, gradual rehabilitation exercises for the cheek muscles can begin, starting with small movements and increasing in intensity and frequency over time.

• For 3 months after discharge, patients must strictly avoid hard foods such as nuts, beef jerky, ribs, and crackers.

What should patients with maxillofacial fractures pay attention to in daily life?

• Strengthen psychological support and counseling to avoid or reduce anxiety and depression, ensuring maximum cooperation with treatment.

• Enhance nutrition to improve physical fitness and promote recovery.

• Maintain hygiene, keep the oral environment clean, rinse frequently, and ensure utensils and eating tools are disinfected and cleaned after use to avoid infection.

Do maxillofacial fracture patients need follow-up examinations? How?

After recovery and discharge, patients must undergo monthly follow-up examinations for the first 3 months. Once the condition stabilizes, follow-ups can be reduced to every 3 months and should continue for 1 to 3 years. Generally, follow-ups can be conducted at a specialized outpatient clinic.

Can maxillofacial fracture patients fly, engage in strenuous exercise, or travel to high-altitude areas?

During or after surgery for maxillofacial fractures, it is generally not recommended to immediately participate in strenuous activities to avoid re-injury and hinder recovery from the primary condition.

PREVENTION

Can maxillofacial fractures be prevented? How to prevent them?

• Maxillofacial fractures are mostly caused by trauma, especially traffic accidents. Therefore, prevention mainly emphasizes enhancing traffic safety awareness and self-protection. For example, avoid using phones while driving, do not jaywalk, and pedestrians should obey traffic rules, such as not running red lights.

• When working at heights or in situations with a risk of falling, secure safety ropes and ensure they are firmly fastened.

• In case of blunt force or external impact, use objects or cover your head with both arms to protect the maxillofacial and cranial areas, minimizing potential injuries.

• If there are infants or young children at home, caregivers should strengthen safety and supervision. Apply corner guards to furniture or wall edges, dress children in loose and comfortable clothing, and choose non-slip, well-fitting shoes. Always supervise to prevent accidental falls.