Facial fractures may occur from a variety of causes: motor vehicle accidents, physical altercations, sports injuries and many other causes. Depending upon their extent and location, surgery to repair them may or may not be indicated.
By seeing a Facial Plastic and Reconstructive Surgeon such as Dr. Colin Pero, you are assured that you will be evaluated and treated by a physician with years of training in Head and Neck Surgery and sub-specialty training in Facial Aesthetic & Cosmetic Surgery. This focus on both your functional and cosmetic outcome is the approach that will allow to move on from your injury with a minimum of recovery time!
The most common type of facial fracture, a “broken nose” is one of the more common fractures in the human body. Swelling, nosebleeds, difficulty breathing and obvious nasal deformity are all possible signs of a fracture following nasal trauma.
Correction of a nasal fracture may be indicated if permanent deformity or breathing obstruction are likely to be the long-term result. “Closed reduction” involves “setting” the displaced nasal bones back in place. This is most commonly done under sedation or general anesthesia for the patient’s comfort. This procedure must typically be done within the first 7-10 days following injury before the bones begin to heal in an improper position.
If significant deviation of the nasal septum is present along with significant deformity to the nose, an “open reduction” may be the better choice for correction of the fracture. This is typically performed a minimum of 6 weeks after injury in order to allow for the swelling to resolve. This involves making incisions inside the nose or in the columella (between the nostrils) as is performed in a rhinoplasty. This allows for more thorough and precise correction of any external deviation or septal deviation in order to improve breathing.
If desired, cosmetic nasal reshaping, or rhinoplasty, may be performed at the same time as open reduction. In addition to correcting the deformity caused by the nasal injury, changes such as narrowing of the nasal tip or reducing a hump on the bridge of the nose may be performed at the same operative session.
Fracture of bone around the eye is termed an orbital fracture, also known as a “blow-out” fracture. The bone at the bottom of the eye socket houses the infraorbital nerve, causing it to be particularly weak in this area. Blows to the eye and eye socket often result in the bone around the nerve fracturing. This can lead to numbness of the cheek and upper lip, double vision and, over time, a “sunken-in” appearance to the eye itself.
Repair of the fracture often involves incisions inside the eyelid or just below the eyelashes, occasionally extending out into one of the creases near the outer corner of the eye. There are many different products available to help repair the fracture including medical grade plastics, titanium and others. Most frequently in Dr. Pero’s practice, completely resorbable plates that are used to hold the contents of the eye socket in place while the bone heals.
Tripod or ZMC (Zygomatico-Maxillary Complex) Fractures
Trauma to the cheek area can lead to fractures of the face in a tripod type of arrangement. The three “legs” of the tripod are the lower rim of the eye socket, the cheekbone itself and the outer rim of the eye socket. Other bones may have fractures associated with them as well.
Symptoms of these fractures include pain and swelling, numbness of the cheek and upper lip on the affected side, a “sunken” appearance to the cheek or eye itself and misalignment of the teeth.
Depending on the location and severity of the fractures, multiple approached may need to be performed, with incisions carefully hidden and camouflaged. Titanium or resorbable plating systems may be used to act as a temporary or permanent “splint” as the bones heal together.