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  Trauma

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  Trauma

Whether the result of an accident or sports-related injury of the face or mouth, trauma can significantly change your appearance and can make breathing and eating difficult.

Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries require special training involving a “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.

Facial trauma can range between minor injury to disfigurement that lasts a lifetime. The face is critical in communicating with others, so it is important to get the best treatment possible. In some cases, immediate surgery is needed to realign fractures before they heal incorrectly. Other injuries will have better outcomes if repairs are done after cuts and swellings have improved.

Pediatric facial trauma differs from adult injury because the face is not fully formed and future growth will be a factor in how the child heals and recovers. Certain types of trauma may cause a delay in the growth or further complicate recovery. Difficult cases require surgeons with great skill to make a repair that will grow with your child.

New technology, such as CT scans and 3D CBCT scans have improved surgeons’ ability to evaluate and manage facial trauma. Arul Dental and Craniofacial hospital uses the 3D Cone Beam CT (3D CBCT) scan- the latest technology in Maxillofacial Imaging. This enables accurate and detailed imaging of facial fractures and that too with a much reduced radiation exposure than conventional CTs. With these modalities under a single roof here, we provide immediate diagnosis and efficient treatment.

Our twin operation theatres are equipped with ultra-modern equipments for the safety of our patients. We have an infection free zone in our operation theatres to cater to dental and facial surgery needs. We follow strict infection control measures and microbiological monitoring protocols.

We have the latest and safest machines including advanced fiberoptic endoscope – a sophisticated anesthesia administration method. Some patients have very limited mouth opening either due to Craniofacial defects, very small jaws or retruded chins. Such patients cannot be subjected to general anesthesia in the traditional way. The flexible Fiberoptic Intubation Endoscope (FFI) is a boon in such instances.

FFI is a most powerful technique for efficient easy intubation of "difficult laryngoscopy" patients otherwise impossible to intubate during general anesthesia.

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  Trauma

In cases of serious trauma to the face, there may be multiple fractures of the facial bones. Commonly fractured bones may involve that of the forehead, cheek, nose and lower jaw. These fractures if not treated effectively have the potential to lead to long-term deformities of the face.

We use 3D Cone Beam CT scan reconstructions, the latest revolutionary cutting edge technology in maxillofacial imaging, for diagnostic support and advanced planning in cases of fractures of the face. This technology enables fast, easy and quick visualization of craniofacial structures with unparalleled precision. These advanced modalities help in complete and successful rehabilitation of trauma and injuries.

Forehead region is the most vulnerable area of the head and forehead bone fractures are very common. Special x-rays called CT scans are used to evaluate fractures and brain involvement and to help plan the surgical reconstruction procedure. Depending on the severity of the fractures, reconstruction is done. The ultimate aim is to achieve as good a functional and cosmetic outcome as possible.

Frontal sinus fracture: The frontal bone or bone of the forehead lodges air-filled space cavities called the frontal sinus. During injuries of the forehead, the walls of the frontal sinus may be fractured. These cases necessitate accurate diagnosis, avoidance of short and long term complications, precise treatment and return of normal sinus function.

Trauma to the temporal area (sides of the forehead) may be critical. As the area involves the ears, complications from such fractures lead to hearing loss or vertigo (feels like the room is spinning around). Although the vertigo may resolve over time, the hearing loss, most of the time, if untreated or inadequately treated, persists. As this part of the face includes the nerves that supplies the entire facial muscles, damage in this area may culminate as Facial Nerve palsy or loss of expression and control of facial expression.

All these conditions need to be properly assessed. Appropriate treatment and therapies need to be instituted based on the extent of damage, duration of swelling, extent of loss of function and other vital parameters.

Eye is one of the key senses that is considered very vital and held close to heart. In case of injuries to the eyes, careful and critical evaluation is performed by a maxillofacial surgeon in addition to a specialist (Ophthalmologist). Initial inspection should not involve manipulation or touching the injured area till fractures of bones around the eye are ruled out.

An expert will ask to move the patient’s eye in all direction to ensure full extent of function, look for the shape, color and vision of the eyeball. Special tests may be performed as needed. The fractures of the bones of the eye need to be assessed by imaging techniques.

Fractures of orbital (eye socket) bones could be of different types depending on the nature of impact, extent of injury, age of the patient besides numerous other factors. These orbital fractures could be anywhere in the adjacent area including cheekbone (zygoma), above the eye, below the eye, or in the bones surrounding the eye socket. Early diagnosis of these fractures is important to avoid some later complications and sequel. Laceration around eyes needs to be carefully worked on as contraction of scars may itself cause loss of vision.

Fractures occur in the lower jaw mainly due to road traffic accidents, sport injuries, fist fights and negligence during extraction. The fractures of the lower jaw are classified on basis of the region involved. The diagnosis can be easily made by means of X-rays .The Mandible (lower jaw) is the strongest bone in the face. The tongue and numerous muscles have attachment in the lower jaw.

Upper jaw fracture

The patient suffered a fracture of his upper jaw bone (Maxilla). As in such cases, the mouth opening gets severely restricted. The fractured site was surgically exposed, the bone fragments were aligned and fixed with bone plate.

Lower jaw fracture

In cases of fractures of the mandible (lower jaw), the fractured segments of bone are stabilized and fixed with bone plates. Subsequent healing of the injury occurs.

Temporomandibular Joint fracture

Condyle fracture: The condyle is a portion of the lower jaw that forms a part of the temporomandibular joint (TMJ or jaw joint). Depending on the type of impact, the condyle may be fractured either on one side or both. The fractured fragment may simply lie in the jaw joint, just a fracture line can be seen without displacement of the broken bone. Or the broken segments may get disrupted. Treatment varies depending upon the extent of injury and resulting position of the fractured bones.

Dr. Arul, an expert at treating jaw fractures, emphasizes on a concise algorithm for diagnosis and treatment of these injuries.

Blunt trauma or a fall may precipitate intraoral injuries. Often children are the victims of such injuries. Occasionally a pencil or toothbrush or a stick and even sharp ends of a toy that is placed in the mouth may cause injury. Such injuries cause simple lacerations, cuts or tears in the mouth and may even cause serious injuries.

Large scale injuries will cause swelling that may choke the airway for breathing. Hence it is prudent that a medical or a dental examination need to be performed. In case troubled breathing is expected, a procedure called tracheostomy has to be performed on an emergency basis to ensure patency of the airway.

Cuts or damage to the palate (the roof of mouth) readily bleeds but spontaneous healing ensures. Cuts or injuries of tongue bleed heavily and require medical help. Slightly large cuts may require stitches and medical management. Deep injuries need surgical attention as the musculature is often delicate and careful handling is needed. Sometimes incision needs to be placed for removal of foreign materials. Careful manipulation is required to prevent formation of scars that could potentially interfere with tongue movements (for speech and chewing) as well as taste sensation.

The bones in the nose are the most frequently broken (fractured) in the face. A successful treatment aims at restoring normal function and appearance.

Cartilage grafts taken from the patient’s rib may be used to rebuild the framework of the nose. Cartilage is an elastic bone-like tissue which can be carved to a desired shape. The carved cartilage can be used for the nasal septum (the central prominence of the nose) or the nose tip or the sides. Since the graft is taken from the patient’s own body, there is no risk of rejection, unlike artificial grafts.

Forehead flaps can also be used to reconstruct the nose. A skin graft is taken from the forehead region and used to rebuild the nose. Since the graft is taken locally, there is no color mismatch.

The graft consisting of a section of the skin along with blood vessels is lifted from the forehead region with the base of the graft still attached to the forehead in between the eyebrows. The wound on the forehead is sutured. The graft is then brought downwards and attached to the nose tip. After blood supply is established in the nose, the graft tissue is cut off from the forehead.

In some cases of trauma, both the right and left condyle may be fractured and displaced. In such instances, the patient’s occlusion or contact between upper and lower teeth gets deranged. The fracture site is surgically exposed, the fractured segments are stabilized and fixed with bone plates. This is done only after accurately restoring the patient’s occlusion.