Jaw and facial fractures: care by an oral and maxillofacial surgeon

A fall, a car or motorcycle accident, a sports injury: a blow to the face can fracture the jaw, the cheekbone or the bones around the eye. The goal is to put every bone back in place so your bite and your face are what they were before. Before I operate, I measure: the CT scan shows me where every fracture line runs, and your bite shows me where each fragment has to end up. I completed my oral and maxillofacial surgery specialty at UNAM in Mexico (2013), I am certified by the Mexican Board of Oral and Maxillofacial Surgery, I have been with the AO Foundation since 2012, and in 2014 I was a speaker at its AO CMF course on maxillo-mandibular reconstruction.

Imaging

CT or cone-beam CT

Fixation

Titanium plates and screws

Approach

From inside the mouth whenever possible

No surgery

Some fractures that didn't shift

When it's indicated

• Your teeth don't meet the way they used to: it is one of the most sensitive signs of a jaw fracture.
• Numbness of the lower lip and chin, or of the cheek and upper lip.
• Pain when opening or closing your mouth, or your jaw shifts to one side as it opens.
• Your cheekbone looks sunken, or you can feel a step along the rim of the eye socket.
• Loose teeth or a cut in the gum over the injury: the fracture may be open to the mouth.
• You were seen in an emergency room and the CT scan shows a fracture: what's left is deciding on surgery.

Before surgery

• Don't wait: a fracture through the teeth is open to the mouth, and a late visit may increase the risk of infection.
• Bring the CT scan (the files, not just the report) and your emergency room paperwork, if you were already seen.
• Until you are seen: soft or liquid food, don't force your mouth open, and cold packs.
• If you smoke, stop now: smoking has been linked to more complications, and it is a factor you can control.
• Tell me about your health conditions and medications, especially blood thinners, lung problems or mouth breathing.

How I plan it

How I do it

1. 01DecisionWith the exam and the CT scan, I explain whether surgery makes sense and why. Cochrane reviewed 12 trials and found insufficient evidence to support any single approach for jaw fractures that don't involve the condyle: it is decided case by case.
2. 02ReductionUnder general anesthesia and, whenever possible, from inside the mouth, I put each fragment back in place using your bite as the guide. Sometimes I hold the teeth together temporarily during surgery to confirm it.
3. 03FixationTitanium plates and screws, following the principles of fracture fixation: anatomical reduction, stable fixation, preserving the bone's blood supply and allowing early movement.
4. 04Follow-upCheck-ups of your bite, the incisions and sensation until the bone has healed. You can message me with any question during recovery.

Recovery

• The first few days bring the most swelling: cold packs, your head raised when you sleep, the prescribed medication and gentle brushing to keep the incisions clean.
• A soft diet for the weeks I tell you, depending on the fracture: chewing hard food too early loads the plates before the bone has healed.
• Antibiotics go before or during surgery; adding more afterwards did not reduce infections across 13 studies, so it isn't routine.
• After a cheekbone fracture it is common for the cheek or upper lip to feel numb: it happened to 51.9% in a review of 13 studies. I measure it at every check-up.
• Check-ups until the bone has healed, which takes weeks; contact sports only once I clear you.

Risks and how I prevent them

Infection

Any fracture through the teeth is open to the mouth. I prevent infection with antibiotics before or during surgery and clean incisions; if it happens, it is treated, and sometimes a plate has to come out.

Bite or bone healing

Jaw fractures carry a relatively high complication rate: a changed bite, poor bone healing or plate failure. I prevent this with the bite as the guide, stable fixation, a soft diet and check-ups; if the bite didn't end up right, I review it and plan how to correct it.

Smoking

Smoking was associated with more complications (odds ratios of 4.04 to 8.09 in three studies). At one center, among 135 people operated on for a jaw angle fracture, 17.2% of those operated on through the neck and 18.8% of those operated on from inside the mouth had a major complication; smoking mattered more than how it was operated on.

Numbness

The blow can injure the nerve to the lip and chin or the one to the cheek. I measure sensation before and after and protect the nerve during surgery; in the cheekbone, decompressing it within two weeks, when indicated, was associated with better recovery.

Condyle surgery

In fractures of the condylar neck, surgery with plates gave less joint pain and fewer bite problems than closed treatment (14 studies). On the other hand, infection was more frequent with surgery, though without statistical certainty, and there is a known risk to the facial nerve. We decide together.

Eyes and vision

Bleeding behind the eye is an emergency: of 93 cases, 22% became blind, and fast treatment was associated with full recovery. At any change in vision, go to the emergency room.

Other options

No surgery

A fracture that didn't shift or change your bite can be managed with a soft diet and follow-up imaging. If it moves, the plan is revisited.

Closed treatment

The teeth are held together with wires or elastics while the bone heals, without opening; it works for stable fractures and some condylar fractures. It reduces breathing function while in place and is not recommended with lung disease or if you breathe through your mouth.

Frequently asked questions