What Are Facial Fractures?

The human face is an intricate and delicate area that contains many bones, muscles, blood vessels and nerves. The bones in your face are thinner than other bones in your body which can make them more prone to injury.

Facial fractures are broken bones in the face. This includes your nose, eye sockets, cheek, upper jaw and lower jaw. Most facial fractures involve the lower jaw but the nose and cheekbones are also commonly damaged. A facial fracture can be painful and unpleasant, and if left untreated, may lead to permanent loss of function (seeing, swallowing, speaking) and disfigurement.

This article will explain everything you need to know about facial fractures, including the different types of facial fractures, the symptoms you may experience, and the available treatment options.

Overview

Facial fractures are broken bones in the face, including your nose, eye sockets, cheek, upper jaw and lower jaw. These fractures are often caused by trauma, such as a car crash or fall. However, they are also common in victims of physical assault and gunshot wounds.

The symptoms of facial fractures depend on the type and severity of the fracture. However, general symptoms include pain and tenderness, bruising, swelling and skin discolouration. Treatment options include painkillers, antibiotics or, in severe cases, reconstructive surgery.

Facial fractures are not life-threatening but some fractures may lead to serious issues with your airway, vision, or central nervous system. If you think you have a facial fracture, you should see a healthcare professional immediately to assess your injury and recommend appropriate treatment. 

Types of facial fractures

There are different types of facial fractures that can affect any part of the face and may even impair function and distort appearance. Severe facial trauma may even cause leakage of the cerebrospinal fluid that surrounds the brain.¹ Types of facial fractures include:

Nasal fractures (broken nose): These are one of the most common types of facial fractures. If left untreated, it can lead to airway damage and cause difficulty breathing.¹ 

Broken jaw (maxillary or mandibular fracture): This is another common facial fracture that can affect your ability to speak, eat, chew and swallow.¹

Zygomatic fractures (cheekbones): This is a cheekbone fracture that involves a group of bones known as the zygomatico-maxillary complex (ZMC). This type of fracture can affect the appearance of the cheek or the lower part of the eye socket. In severe cases, this can compress nerves and the muscles involved in chewing which can result in pain when chewing or the inability of the mouth to fully open (trismus).¹

Forehead fractures (broken frontal bone): These are fractures to the frontal bone.¹

Midface fracture (upper maxillary fracture): This includes the three Le Fort fracture -  

• Le Fort I fracture - occurs from a blow in a horizontal line above the teeth and below the nose
• Le Fort II fracture - occurs from a force to the midface
• Le Fort III fracture - This involves a horizontal fracture across the back of the eye sockets. This type of fracture may cause cerebrospinal fluid leakage²

Orbital fracture (broken eye socket): This type of fracture may include - 

• Orbital rim fracture - occurs from a force in the outer edges of the eye socket bone
• Orbital floor fracture (or blowout fracture) - occurs from a direct blow to the face that causes the bone in the bottom of the eye socket to fracture and create a hole. This can result in a black eye, pain and vision problems¹

Causes of facial fractures

The most common causes of facial trauma are:

• Physical assault
• Falls
• Motor vehicle accidents
• Sports-related injuries
• Being hit by a blunt object
• Disease e.g. infection of the bone (osteomyelitis)
• Workplace accidents

There has been an increased occurrence of facial trauma in the last few decades due to the growing incidence of motor vehicle accidents and violence. As well as this, facial skin and bone are more exposed to trauma compared to other parts of the body. The skin is thin and elastic so external trauma can lead to soft tissue injuries such as lacerations, cuts, nerve damage as well as facial fractures.³

Facial fractures are more common in people assigned male at birth (AMAB) around the ages of 15-40 years old than people assigned female at birth (AFAB). Current research shows that there is an association between violence, driving, alcohol use and drug use with an increasing occurrence of facial trauma. Less severe facial fractures are often correlated with physical aggression, whereas more complex fractures are correlated with motor vehicle accidents.³

In children, facial fractures commonly occur as a result of games and child play, whereas in the elderly, facial fractures occur due to falls at home.³

Signs and symptoms of facial fractures

The symptoms of facial fractures depend on the type of facial fracture but general symptoms include:

• Pain and tenderness
• Swelling
• Bruising
• Skin discolouration
• Disfigurement

If you have a broken nose, symptoms may include:

• Nosebleeds
• Crackling noises in your nose
• Difficulty breathing through the nose

If you have a fractured jaw (mandibular fracture)⁵ you may have:

• Difficulty speaking or chewing
• Dental fractures
• Drooling
• Pain when opening your mouth

If you have a fractured eye socket (orbital fracture),⁶ you may have:

• Sunken eyeballs
• Blurred or double vision
• Bulging eyeballs
• Difficulty moving your eyeballs

Management and treatment for facial fractures

Your healthcare provider will discuss possible treatment options for you. Treatment options depend on the type and extent of the facial trauma. You may be prescribed painkillers to ease swelling or antibiotics if there is a risk of infection. Most facial fractures have normal alignment and, therefore require little treatment and usually heal themselves over 4-6 weeks. However, if the fracture is not in alignment, treatment will require reduction and fixation to reset the broken bones into normal alignment. 

Reduction - this involves resetting the broken bones and restoring them to their correct position. This can be done a few days after the injury once the swelling has subsided.

Fixation - this involves holding the broken bones together in their new position long enough for them to rejoin and heal. This sometimes involves surgical plates, screws and wires.

Resetting bones can be done manually, without surgery (closed reduction), or it may require surgery (open reduction). Reconstructive surgery is usually required for more complex facial trauma where multiple bones are broken. The main goal of reconstructive surgery is to:

• Restore normal facial functions - e.g. swallowing, breathing, chewing, vision
• Optimise appearance

Recovery depends on the extent of the facial trauma. For most people, bruising and swelling usually fade after 2 weeks but it may take a few months to completely recover.

Diagnosis

To diagnose facial fractures, a healthcare provider will:

• Examine your face and feel for any bone fragments or irregularities
• Look inside your nose and mouth for possible obstruction
• Look inside your nose or ear for blood clots or cerebrospinal fluid
• Examine your eyes for possible vision issues
• Check for damage to your central nervous system (your brain and spinal cord)
• Ask about your symptoms and how your facial injury occurred

A healthcare provider can also use imaging tests to diagnose a facial fracture. An X-ray can be used to identify a facial fracture and rule out other issues, such as neck fractures and dislocation. Another common imaging test that is used is a computed tomography (CT) scan, which can be used for patients with multiple facial traumas. This is the most effective way to assess a facial fracture as it produces images of soft tissue, bone, blood vessels and other structures.¹

If surgery is needed, a surgeon may require additional images to plan the surgical procedure.¹

Risk factors

You have a higher risk for facial trauma if:

• You do not wear a seatbelt in a motor vehicle
• You do not wear a helmet when riding/driving a motorcycle
• You do not wear protective equipment when playing sports or at work

Complications

Some people may experience complications following facial trauma, such as:¹

• Headaches
• Sinus issues
• Breathing issues
• Vision issues
• Dental fractures
• Leakage of cerebrospinal fluid
• Eye injuries
• Swollen tissue
• Blood clots

It is important to treat facial fractures as soon as possible to reduce your risk of long-term complications.¹

FAQs

How can I prevent facial fractures?

There is no sure way to prevent facial fractures but you can take steps to reduce your risk by:

• Wearing a seatbelt when driving or riding in a motor vehicle
• Wearing protective equipment when playing sports or working
• Following safety guidelines at work

How common are facial fractures?

Facial fractures are very common and affect around 7 million people per year, worldwide.⁴

When should I see a doctor?

You should see a doctor right away if you have any signs of facial trauma to reduce your risk of long-term complications. You should seek immediate medical care if you have:

• Worsening pain
• Signs of infection-redness, fever
• Trouble breathing or swallowing 
• Vision problems
• A displaced jaw or nose
• An open wound
• Loss of teeth

Summary

Facial fractures are broken bones in the face. There are different types of facial fractures including nasal fractures, forehead fractures, orbital fractures (eye sockets), cheekbone fractures, broken jaw and le fort fractures. The most common causes of facial fractures are motor vehicle accidents, falls and physical assault. Signs and symptoms of facial trauma depend on the type and severity of the fracture but general symptoms include pain and tenderness, bruising, disfigurement and skin discolouration. Treatment of facial fractures includes reduction which involves resetting the broken bones and restoring them to their correct position and fixation which involves holding the broken bones in their new position long enough for them to heal. This can either be done manually or through reconstructive surgery.

If left untreated, facial trauma can lead to long-term complications including vision problems, sinus issues, breathing issues, dental fractures and leakage of cerebrospinal fluid. There is no sure way of preventing facial injuries but to reduce your risk you should wear a seatbelt when driving or riding a motor vehicle, wear protective equipment at work or when playing sports and follow safety guidelines at work.