Fractured Jaw, Facial Injury
The fundamental basis of much of our training as Oral and Maxillofacial Surgeons, is maxillofacial trauma. In fact, many of the reconstructive techniques commonly used today, are of origin and developed out of necessity, to repair traumatic injuries of the facial skeleton. Our natural comfort with caring for the facial trauma patient is therefore apparent. A bulk of current literature with respect to facial trauma is found in the Oral and Maxillofacial Surgery literature.
Facial trauma is frequently treated by overlapping surgical specialties, including Plastic Surgery, Otorhinolaryngology (ENT), and Oral and Maxillofacial Surgery. Unfortunately, training and experience do not have commonality between these specialties or for that matter within the specialties. Surgical residency training differs greatly in the volume of experience and scope of care provided. Therefore, one cannot assume surgical expertise merely by evidence of specialty training or title.
The following types of facial trauma cases are routinely treated:
- Mid-facial fractures (LeForte I, II, & III type mid-face fractures)
- Zygomatic arch and Zygomatic Complex (cheek bone) fractures
- Naso-orbital-ethmoid (NOE) fractures
- Orbital Rim and Orbital Wall fractures (orbital blow out fractures)
- Nasal fractures
- Mandibular (lower jaw) fractures
- Dental and Dentoalveolar injuries (teeth and adjacent structures)
- Facial soft tissue injuries (simple and complex facial lacerations)
- Missile and penetrating injuries to the facial skeleton (gun shot and stab wounds to the face)
Injuries to the Teeth and Surrounding Dental Structures
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral and Maxillofacial Surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth which have been displaced or “knocked out”. These types of injuries are treated by one of a number of forms of “splinting” (stabilizing by wiring or bonding teeth together).
What Should You Do If You Knock A Tooth Out?
If a tooth is “knocked out”, it should be rapidly placed back in the tooth socket if at all possible. Simply rinsing the tooth with tap water and reinserting it into the dental socket will preserve the delicate ligamental surface of the root and the prognosis for reattachment. Deciduous (baby) teeth are generally not replanted due to their poor prognosis for retention.
Keeping the tooth moist is most critical. Other alternatives include placing the tooth in the mouth between the cheek and gum, placing the tooth in dilute salt water (1/2 tsp salt in 8 -12 oz glass of water) or milk. The sooner the tooth is re-inserted into the dental socket, the better for the survival of the tooth. Therefore, the patient should see a dentist or Oral & Maxillofacial Surgeon as soon as possible. Never attempt to “wipe the tooth off”, since remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. You may gently rinse the tooth in cool water of before reinserting into the socket. A tooth that has been out of the socket more than 90 minutes has a rapidly decreasing chance for successful reattachment and long-term retention.
Other dental specialists such as an endodontist (root canal specialist) may be called upon to perform root canal therapy on the avulsed tooth, and/or a restorative dentist who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as predictable replacements for missing teeth.