Immediate hospitalization required to diagnose and treat facial trauma

By:Dr. Leonard V. Infranco
   Nobody likes to sustain an injury to the face, but the reality is that many people do over the course of a lifetime. Today’s medical techniques and imaging equipment go a long way toward helping doctors restore patients to the same quality of life they enjoyed before the injury.
   Of the many kinds of facial injuries, by far the most common and most mild is the fracturing or loss of a tooth. Tooth injuries can range from a chipped tooth to a fractured tooth where the nerve has been exposed, to a knocked out tooth.
   In each case, the patient should be seen by a doctor and have an X-ray of the mouth taken. For a chipped tooth, typically all the patient needs is a bonded filling. When a tooth is fractured, however, it is more serious. The doctor will first determine whether just the crown is gone, if the root is still intact, and if the nerve is exposed.
   The most severe injury involves the fracture of the root below the bone. In the event that this happens, an oral surgeon will remove the root and a replacement tooth will be made.
   One of the most common injuries that affects children and sports players is the avulsion of a tooth. This involves knocking the tooth out completely, and for anyone who has ever witnessed this, it can spark an immediate sense of panic for both the injured party and anyone close by.
   This reaction is not unfounded, as timing is everything when it comes to re-implanting the tooth. If the tooth can be rinsed off and re-implanted within 30 minutes of the injury, there is a 90 percent success rate. If two or more hours elapses, however, the success rate plunges to a mere 5 percent. One of the most important things to remember is to keep the tooth moist at all times. If the avulsed tooth is a baby tooth, however, nothing is done, though an X-ray is needed to assess if there is any damage to the underlying adult tooth.
   While it may sound unappetizing, one of the best ways to transport a tooth if you cannot place it back into the socket is to keep it tucked under the patient’s tongue until you can get to the hospital. The saliva present in your mouth will help prevent the tooth from dying.
   Other acceptable ways to keep the tooth moist include storing it in a cup of milk or a saline solution made from adding one teaspoon of salt to an 8 ounce glass of water, or wrapping it in a saliva-soaked towel. If possible, avoid storing it in plain tap water and never allow it to dry out.
   If you can slide it back into place, hold it there and take the injured person to the emergency room. Once at the hospital, the tooth will be splinted into place to keep it from moving and will remain in place for seven to 10 days. After that time, a conservative root canal treatment will complete the process.
   Lacerations of the lip and tongue are other common forms of facial trauma. The location, depth, and length of the cut will determine whether or not the laceration will require suturing. Aesthetic concerns also come into play, as suturing a lip will reduce scarring and healing time.
   Fractures play a major role in facial trauma. One of the most common facial fractures is to the mandible or lower jaw and the majority of fractures occur to males ages 16-30. Assaults and auto injuries are the most common reasons given for these fractures.
   Fortunately, seat belt laws and the presence of air bags in vehicles is having a positive effect, forcing a decline in the number of fractures due to auto accidents. Within the last 10 years, it is estimated that 43 percent of lower jaw fractures are due to auto accidents, 34 percent are a result of assault, 7 percent are work related, 7 percent are due to falls, and only 4 percent can be chalked up to sports-related accidents. The widespread use of mouth guards and other protective equipment helps keep sports injuries at the bottom of the fractured jaw list.
   Other facial fractures include the dentoalveolar (the portion of the bone that holds teeth in place), zygoma (cheekbone), maxillary (upper jaw), nasal bone and orbits (eye sockets).
   How do you know if you have a broken bone in your face? Pain, swelling and bruising are the three main things to consider. Also, changes in your bite, aesthetic deformity such as the dimpling of a cheek, lacerations, double vision and localized numbness that indicates nerve injuries that traverse through the bone may be present.
   The vast majority of these injuries are treated in an operating room setting. Once the patient comes to the emergency room, the emergency room team will stabilize the patient, a doctor will evaluate the patient’s condition and look for other injuries that may have been sustained, and the patient will receive treatment in an operating room.
   Because it is possible for a patient who has suffered a mid-face fracture to also sustain cervical spine injuries, it is very important to be examined by a doctor. Diagnosis helps plan the treatment and a good screening tool to help doctors is a CT scanner. New imaging equipment helps the surgeon know where the fracture is and see the degree of bone separation. CT scans can generate three-dimensional images that help surgeons plan their procedures.
   When it comes to fractures, there are two ways to treat them. The first is an open reduction. This involves opening the fracture by making incisions and placing titanium plates and screws in place to fixate fracture segments. The second method is a closed reduction which involves wiring the patient’s jaws shut.
   No incisions are made and there are minimal surgical risks involved. Instead, arch bars, a type of brace, are applied to the teeth and the braces are hooked together, essentially wiring shut the mouth. Once the patient’s mouth has been wired shut, it will remain so for four to six weeks, meaning that the patient must endure a liquid diet.
   When it comes to dealing with facial trauma, it is essential to visit the hospital where you can be diagnosed, stabilized and treated. No matter what injuries you have sustained, treatment is available.?
Dr. Leonard V. Infranco is an oral surgeon on staff at The Medical Center at Princeton. Health Matters appears Fridays in the Lifestyle section of The Packet and is contributed by The Medical Center at Princeton.