Among the most frequent diseases of the maxillofacial district, traumatology is certainly the most represented. In the ASL of Frosinone, the UOSD of Maxillofacial Surgery, directed by Dr. Andrea Marzetti, deals with the delicate management of fractures of the facial mass that require special and detailed care and attention since the face is a district with a high aesthetic and functional impact.
What bones can fracture?
Fractures can affect one or more of the various bone segments: cheekbone, jawbone, nasal bones, orbit, and frontal bone. The bones least resistant to a traumatic insult are the nasal bones, the orbital floor but also the zygomatic arch. The most complex and dramatic picture is represented by the facial roar where almost all the facial bones are involved, often on both sides.
What are the most common causes?
The most common causes are related to road accidents, sports traumas (e.g. football, rugby, tennis, horseback riding), accidental falls in the home or on the street but also beatings and ballistic traumas. The most serious situations occur following road accidents without the protection of the seat belt.
What are the symptoms with which they manifest?
Symptoms vary depending on the area affected by the trauma.
A fracture of the mandible or maxilla causes an alteration of occlusion and usually loss of dental elements.
A fracture of the orbit with floor involvement and fall of the periorbital contents in the maxillary sinus (this fracture is called “blow-out“) causes a displacement of the eyeball on the side of the fracture with possible double vision, swelling in the orbital region and inability to open the eyelids due to the haematoma.
The fracture of the zygomatic bone often is associated with the fracture of the orbital floor and causes an aesthetic alteration with sinking of the zygomatic knob.
The fracture of the zygomatic arch may limit the normal opening and closing movements of the mouth due to interference of the coronoid process of the mandible with the zygomatic arch.
More serious can be the consequences of a fracture involving the frontal bone or the ethmoid for possible direct involvement of the brain.
How is facial mass fracture diagnosed?
After a careful physical examination, the diagnosis is made with a CT scan of the facial mass that can now be reconstructed in 3 dimensions. Very useful and in some cases fundamental is the ophthalmological and orthoptic evaluation.
How is fracture treated?
The surgical treatment of massive-facial fractures must be as early as possible unless there are several complications and the aim is to restore the continuity of the bones of the face in order to guarantee a rapid morphological and functional recovery. The “repair” of the facial skeleton takes place in the operating room under general anaesthesia and consists of repositioning the bone fragments and fixing them with tiny titanium plates and screws. Of great help especially in the fractures and fractures of the orbit where the anatomical references are lost, is the neuronavigation that allows to identify at all times the noble structures to be preserved.
Is it a very painful procedure?
Contrary to expectations after surgery, patients experience less pain than in the preoperative period and the discomfort is usually managed with ice and common painkillers.
How long is the hospital stay and what are the recovery times?
After surgery, the hospital stay lasts a few days unless there are other complications. The fracture will tend to “heal” in a fixed time of 40 days. Usually sports activities cannot be resumed before 40 days post-operative. Titanium plates and screws do not create problems for radiological examinations such as CT and MRI and are usually not removed.
Functional recovery after an operation of this type varies from case to case but generally does not exceed 30-40 days although some problems related to the fracture such as alteration of skin sensitivity require months before a satisfactory restoration.
By UOSD Maxillofacial Surgery
