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Craniofacial Program

Trauma

The SickKids Centre for Craniofacial Care and research treats trauma to the head and face. Here is some information on the different types of trauma we see.

Nasal Trauma

trauma-nasalzyg image

Fractures involving the nose are the most common forms of facial fractures sustained by children. Fortunately nasal fractures are not usually serious and are simply diagnosed by careful inspection. Initial treatment usually involves stopping a nose bleed with simple pressure. If the nasal bones are pushed out of position, an operation is usually required to straighten them. The timing of this operation depends on several factors and may be done immediately or after 5 to 7 days when the swelling settles. If the treatment is delayed beyond 2 weeks, the nasal bones may have to be re-broken in order to reposition them. Usually a cast is applied to the nose for a week for protection. Sometimes there are some remaining deformities such as a bump on the bridge of the nose that requires surgical attention after everything is healed several months later.

 

 

 

Fractures of the Eye Socket (Orbital Fractures)

trauma-orbital image

Fractures of the eye socket (orbit) can occur in combination with fractures of the cheek bone (zygoma) or as an isolated event, usually involving the floor of the orbit. Very commonly this is following a punch or a blow to the eye. As a result of a fracture involving the floor of the eye socket, the muscles that move the eye can become trapped in the fracture impairing eye movements and as a result patients may complain of double vision.

trauma-orbitalimp image

Investigation to manage this problem begins with a CT scan and involves being assessed by an Ophthalmologist to make sure that the vision has not been affected.

 If there is a significant amount of tissue trapped in the fracture site or if the site of the fracture is particularly large, an operation is required to repair the eye socket. This operation is performed using an incision along the lower eyelid and involves releasing the entrapped tissue and reconstructing any missing bone along the area of the fracture. Often an artificial implant is used for this purpose, but bone graft taken from the skull or the hip may also be used. The recovery period may be associated with some temporary double vision which can take several months to improve.

 

 

Fractures of the Cheek Bone (Zygoma)

trauma-zygoma image

Fractures of the cheek bone (zygoma) are usually associated with a punch or a fall. The patients can present with deformity such as swelling or change in the position of the cheek bone in association with difficulty in moving the eye or change in position of the eye. This is because the cheek bone forms a significant portion of the eye socket (orbit). Numbness along the cheek and side of the nose is a common symptom in these types of injuries.

Treatment of the fractured cheek bone depends on several factors that include the amount of displacement of the bone fragments and the extent of injury that has occurred to the floor of the eye socket. Surgery involves replacing the cheek bone into its proper position and holding it in place with some small metal plates and screws that are placed in incisions adjacent to the eyebrow in the upper mouth and occasionally in the lower eyelid. Recovery is usually associated with some numbness involving the lip, cheek and nose but this settles after several months.   

 

Fractures of the Lower Jaw (Mandible)

trauma-mandible image

Fractures involving the mandible (lower jaw) can occur following a fall, a fight or car accident. Patients will complain of pain and difficulty opening their mouths. The teeth may not fit together in their normal pattern. Occasionally there may be numbness involving the lower lip and chin.

The treatment of these injuries involves obtaining special x-rays such as a Panorex or a CT scan to confirm the diagnosis of the fracture. If the bones are significantly shifted out of position, an operation is required to restore the normal occlusion. This may involve wiring the patient’s teeth together for a period of time (arch bars).  A plate and screws may also be used to fix the fracture and maintain its position.\

Recovery phase involves a period of soft diet and careful mouth care. Certain types of mandibular fractures may be prone to growth disturbances at a later date and may require orthodontic appliances (braces) and or further surgery if this is the case.

   
panorex x-rays of mandible fractures treated with arch bars and a plate

Fractures of the Forehead (Frontal Bone)

trauma-frontal image

Fractures involving the forehead (frontal bone) can be quite serious as it usually takes a high amount of energy to create a fracture in this area. The brain is susceptible to injury as it is located just behind the fontal bone. Young children are particularly prone, given the relative size of their forehead compared to the rest of their face and the fact that they do not have a frontal sinus to protect the brain.

The treatment of forehead fractures involves a CT scan to make sure that there is no brain injury as well as a consultation with the Neurosurgeons. If the fractures are displaced out of position usually an operation is required through incisions placed in the scalp behind the hairline. No hair is shaved during this procedure.

Recovery following surgery for forehead fractures is usually uneventful but depends on the extent of any underlying brain injury. 

Fractures Involving the Upper Jaw (Maxilla)

trauma-maxilla image

Fractures involving the upper jaw (maxilla) are similar to those involving the lower jaw in that patients complain that their teeth do not fit together. However it usually requires a higher amount of energy to fracture the upper jaw and as such these are more commonly seen after significant falls or car accidents. The diagnosis of a maxillary fracture is made by physical examination and a CT scan. The treatment involves an operation to return the teeth to their proper position, often with the aid of small metal plates and screws. During the recovery phase patients are maintained on a soft diet and require diligent mouth care during the healing phase.