Facial Trauma & Fractures | Eating, hygiene and recovery

A soft diet reduces fracture motion and bite force while healing begins. If intermaxillary fixation is used, patients can still feed by mouth with semi-solid or liquid foods, often using a feeding cup or straw; 2000–2500 calories daily is adequate for most. Because liquid diets can be tedious, small frequent meals help, and a dietician can balance nutrients. Milk products are encouraged, followed by meticulous oral hygiene, with possible vitamin, iron or protein supplements. For minimally displaced or medically unfit edentulous fractures, a dental soft diet may be used, but nonunion or malunion can occur. Your surgeon will tailor texture and timing to your fracture and fixation, and monitor healing.

Effective oral hygiene helps prevent infection when a fracture involves the oral cavity. For the first 24 hours after surgery, no mouth cleansing is advised because it may start bleeding; after that, mucous membranes and teeth may be cleansed carefully with a soft toothbrush or foam pads, and the mouth irrigated with 0.2% aqueous chlorhexidine after every meal. Intraoral sutures can trap food, so clinging debris should be swabbed with cotton wool each day. A hypertonic saline mouth bath may be used without violent flushing. Conscious patients may use 0.2% chlorhexidine gluconate mouthwash three to four times daily, with soft brushing after meals while avoiding intraoral wounds; arch bars can be cleaned with toothbrush and paste, and lips kept lubricated.

Facial injuries raise vomiting risk because swallowed blood, a full stomach, alcohol intoxication or brain injury can trigger it. Swallowed blood is a potent stimulus, and these factors are commonly associated with facial trauma. If you are not fully conscious, or have significant facial injury, clinicians may need to protect the airway, sometimes with intubation, because blood and mucus can obstruct breathing. Suction can clear the pharynx, but stimulating the soft palate may trigger more vomiting; lying on the side may help drainage if other injuries allow. Fortunately, most patients with minor or moderate facial injuries do not vomit or require urgent measures to secure the airway.

After some orbital fractures, especially those involving the paranasal sinuses, blowing the nose can force air or fluid into surrounding tissues and raise pressure. One source advises avoiding nose blowing for 10 days in acute orbital fractures involving the paranasal sinuses, with antibiotics considered because acute orbital cellulitis can threaten sight. For medial orbital wall fractures, another source advises avoiding nose blowing for 6 weeks and sneezing with an open mouth to minimize elevation of intraocular pressure. The exact restriction depends on fracture type, displacement and whether surgery is needed. Your surgeon will carefully tailor advice to your imaging, symptoms and recovery.

Facial fractures differ by bone, displacement, fixation and soft-tissue injury, so healing is not the same for everyone. For mandible fractures, one source says there is no hard evidence for return to full physical activity, but six weeks should be long enough in fit young patients for good clinical union, so a significant blow would be needed to re-fracture the mandible. Risk still varies by activity, and each case must be considered on its merits. Complete bone healing takes several months longer. This six-week point is clinical union, not complete healing, and the source is about mandible fractures rather than every facial bone.

Facial fractures can affect nerves supplying the lip, cheek or teeth, so numbness or altered sensation may follow injury or surgery. Recovery varies with the nerve involved, injury severity and healing. Some numbness may often improve gradually over time in many cases. Some nerve damage may be temporary, while other injuries may take 18 months or longer to recover. Your surgeon will assess which nerve is involved, whether numbness comes from bruising, stretching or direct injury, and whether sensation is returning. Not every fracture affects nerves, and recovery cannot be predicted exactly. Recovery timelines are estimates, and your surgeon will tailor advice to your injury.

Whether exercises are needed depends on the injury and treatment. Limitation can follow coronal-flap surgery because of temporalis muscle fibrosis, or certain condyle fractures, especially intracapsular ones. Even fractures not involving the condyle may reduce overall mobility and closing force. If elastics or immobilization were used, patients are encouraged to use their jaws as much as possible from the first postoperative day. Physiotherapy may include maximum opening, lateral excursions to both sides, and protrusive movements, often at least four times daily. During these exercises, eating, and oral hygiene, elastics can be removed carefully as directed by your surgeon. Persistent limitation two weeks after surgery may warrant physiotherapy and follow-up with your surgeon.

A change in bite is highly suggestive of a mandibular fracture, but it can also result from fractured teeth, a fractured alveolar process, a mandibular fracture at any location, or trauma to the temporomandibular joint and chewing muscles. Post-traumatic premature posterior dental contact or an anterior open bite may result from bilateral fractures of the mandibular condyle or angle and from maxillary fractures with inferior displacement. Facial trauma examination also looks for malocclusion and step-offs between teeth. Because several structures can be involved, your surgeon may need imaging and a careful bite check rather than assuming one cause. This is why prompt review matters.

Monitoring includes an initial five-point eye examination repeated during treatment, with objective assessment of eye movements in each direction of gaze. Persistent diplopia at two weeks and beyond is a key observation point. Some studies suggest delayed surgery may have a lower chance of curing symptomatic diplopia, while others report similar resolution with early or delayed intervention. Kersten and colleagues prefer prolonged observation for most orbital fractures, except trapdoor fractures with marked limitation. Because double vision is often due to contusion and scarring, late bone treatment may not improve it unless entrapment or sagging is present; eye muscle surgery may then be considered.

Infection is the most common adverse event after mandibular fracture treatment, with reported rates from 2.9% to 30%, while postoperative infection is uncommon after isolated zygomatic fractures and extremely low in that setting. Compound mandibular fractures are of particular concern, and about half of such patients without antibiotic prophylaxis may develop infection at the fracture site. If infection is diagnosed, a wound culture is taken and intravenous antibiotics are started. If imaging shows fracture displacement, bone sequestrum or a plate-related complication, the fracture may be explored and foreign or necrotic material removed; teeth in the fracture line may be extracted, occlusion re-established, and replating or bone grafting considered depending on bone contact.