Facial Trauma & Fractures | Repair choices

The surgeon reaches the fracture through skin, mouth lining or eyelid lining, then realigns it directly and fixes it with a plate, screw or wire. Whether ORIF is needed depends on fracture type, displacement, comminution and stability; some fractures are treated closed or observed. Stable fixation matters because loose hardware can inflame or infect. Bone quality and fragment size also affect whether screws hold. In children, rigid fixation is often standard. For isolated nasal fractures, internal stabilization is not preferentially used. Treatment is individualized by displacement at each articulation and predicted aesthetic or functional deficits; severe cases may need extensive reconstruction. The surgeon also checks bone quality and fragment size before operating, because fixation must stay stable while healing.

Adult facial hardware is now almost always titanium, which is strong and generally well tolerated, but surgeons still debate leaving it permanently. Many recommend removal once healing is adequate; others feel a second operation's risks outweigh leaving it. Urgent removal is more likely with infection, wound opening, hardware exposure or discomfort. Stainless steel and large rigid plates are usually removed; titanium often remains unless loosening or symptoms occur. Low-profile plates are especially likely to stay if not bothersome. Removal may be considered if hardware is palpable or visible after sufficient healing. Biodegradable plates may suit children because permanent fixation during facial growth is not ideal.

Intraoral incisions are often used for mandibular and maxillary fractures; a sublabial incision gives wide maxillary access. The orbit is commonly approached transconjunctivally, while upper facial, nasal root, nasoethmoid and zygomatic fractures may need a coronal scalp incision. Incisions within or parallel to natural creases or lines of minimal tension usually become less conspicuous, whereas incisions crossing a crease are often more visible. Existing traumatic lacerations may sometimes be used. Complex or comminuted fractures may require wider or extraoral exposure for safe reduction and fixation. Treatment is individualized by displacement, comminution and stability. The surgeon must protect nearby nerves and blood supply. Healing and scar maturation vary by person and incision site.

Orbital floor or wall fractures can let fat or muscle slip into the sinus, changing orbital volume and eye position. Surgery is considered when CT shows significant herniation, soft tissue is trapped, or there is early enophthalmos. In children, muscle entrapment may need urgent treatment. Implant placement must avoid the optic nerve and maxillary sinus. Silicone implants are discouraged because of infection risk. Loss of 50% or more of the orbital floor can risk late enophthalmos, and repair may be combined with associated midface or skull fractures. A gentle eye-movement check can confirm restored movement. The overlying periorbita often avoids need for fixation of implant material.

Entrapment is uncommon, so clinicians distinguish true restriction from muscle weakness or swelling. A forced duction test can be used in selected cases to rule out entrapment, and visual acuity should be assessed before surgery. If repair is needed, orbital wall reconstruction in addition to muscle release is associated with better postoperative outcomes than release alone. A transconjunctival approach is generally favored, with transcaruncular access for medial wall fractures; reconstruction may use gel film sheeting, titanium plates, calvarial bone grafts or porous polyethylene, while silicone implants are discouraged because of infection risk. Intraoperative forced duction testing helps ensure no entrapment remains after implant placement.

Modern rigid fixation with plates and screws usually makes jaw wiring unnecessary, because the bone is held firmly while healing. Wire fixation is less rigid, so temporary jaw wiring is usually needed to keep fragments from moving. Many patients with facial bone fractures are managed without prolonged jaw immobilization and can eat softer foods; if wires are used, a semi-solid or liquid diet is possible. The exact plan depends on fracture location, displacement, stability, and whether teeth or bone segments were lost. Teeth or dentoalveolar segments may have been lost during injury, or bony segments may not be salvageable. Dr. Purohit can discuss this during consultation in Jaipur. He can also explain feeding, oral hygiene and follow-up.

Standard intermaxillary fixation relies on teeth, so missing teeth or dentures complicate it. A full denture can be stabilised to the mandible with circummandibular wires, while partial dentures may be secured with arch bars attached to remaining teeth. Intermaxillary fixation screws placed in the alveolus between roots offer rapid fixation under local anaesthetic and help when crown or bridgework makes arch bars difficult, but improper placement can damage tooth roots or the mental nerve. With poor dentition, anatomic alignment may be used instead of restoring bite. The surgeon chooses closed or open reduction based on fracture displacement and stability. Teeth retained in the fracture line need careful postoperative monitoring.

The goal is to restore your preinjury appearance and function, and the definitive repair is carried out in one operative procedure, so careful evaluation, diagnosis and preoperative planning are critical. Complex facial fractures may be treated simultaneously according to facial thirds and associated neurological compromise. However, if you have severe general injuries, definitive facial management may need to be postponed while life-threatening problems are treated first. Facial trauma may also accompany brain injury, cerebrospinal fluid leak or vision problems, so a team approach is important. Treatment is individualized by fracture severity and associated injuries. Some fractures may be temporarily stabilized first, then definitively managed later.

Fresh facial fractures result from mechanical overload and disrupt bone and blood supply, but the face has abundant blood supply that supports healing and resistance to infection. Callus forms when there is some mobility during healing, then remodels into mature bone. In contrast, when soft tissue heals over malreduced fragments, it can form a dense internal scar and stiff web that opposes restoring preinjury shape even if bone is later repositioned. Delayed deformities may show brow malposition, lack of malar projection, enophthalmos or infraorbital rim loss. Management depends on displacement and predicted aesthetic and functional deficits, ranging from observation to open reduction and fixation.