Craniofacial injury

General information

Craniofacial injuries refer to trauma or damage to the skull or facial bones, often caused by accidents or falls and they are most often combined with craniocerebral trauma. Surgical treatment of this group of patients is usually performed by the department of emergency neurosurgery. The most common causes of injuries are traffic accidents, violent trauma, and falls from heights.

Emergency care is provided for maxillofacial injuries combined with craniocerebral trauma. Surgeries are usually performed as an emergency. After performing urgent interventions, after a short recovery period, early secondary surgeries are performed, as well as surgeries for remote consequences of craniofacial trauma. During this period, temporary anatomy and function disorders become stable, and deformation of the facial skeleton and systemic function disorders: masticatory apparatus, temporomandibular joint, upper respiratory tract, visual organs, neurological disorders, and cosmetic defects occur.

Injuries to the jaw and nose occupy a special place in terms of functional and aesthetic impairment and can occur for many reasons:

• accidents at home and on the street;
• sports accidents;
• traffic accidents;
• fights, etc.

The head and face are critical areas where almost all sensory organs (eyes, ears, tongue, nose) and a significant part of the central nervous system (brain and upper spinal cord) are concentrated. The respiratory and digestive tracts also originate here. In this regard, surgical treatment of facial and head injuries requires high qualification and great practical experience of the doctor.

In 90% of cases, these injuries are accompanied by injuries to other body areas. For example, one-third of patients are diagnosed with simultaneous injuries to the upper or lower extremities and chest. 40% of patients with craniofacial injuries experience loss of consciousness. Unfortunately, statistics show that about 8% of head and facial injuries are fatal. Therefore, after the initial examination, medical care is provided according to the urgency of the symptoms:

1. The first thing to check is whether the victim is bleeding profusely or has respiratory distress. If there are any, they should be corrected immediately to save the patient’s life.
2. In almost all situations, a special cervical “collar” is recommended to secure the spine in case of a probable fracture.
3. Nasal bone fractures, jaw fractures, and soft tissue injuries should be evaluated comprehensively after the first two things have been accomplished.

When examining patients with head and facial trauma, physicians assess for soreness of the affected soft tissues, double vision, facial asymmetry, problems with teeth clenching, and loss of sensation. In addition, each patient should undergo an eye exam and oral and nasal exams.

After the examination, a specialist in the Maxillofacial Surgery Department may prescribe a CT scan for the patient. CT diagnostics help accurately assess the condition of the brain and facial bones and, if necessary, prepare for surgery by modeling them on a computer. The resulting three-dimensional images will provide the patient and their family with clear information.

The most common injuries to the facial bones are fractures:

• of the nasal bones;
• of the upper and lower jaw, as well as the jaw joints;
• of the zygomatic bones;
• of the bony floor of the ocular orbit;
• of the frontal sinus;
• complicated multiple fractures.

Diagnosis

Today, the most modern devices and technologies, such as CT and MRI, ultrasound, angiography, and other modern diagnostic methods, are used to diagnose this pathology. An algorithm of radial diagnostics also allows optimal visualization of facial and cranial injuries in victims with craniocerebral injuries and anatomic-physiological disorders. 

Treatment methods for craniofacial injuries

The gold standard in the treatment of craniofacial injuries, is to join the fragments using small plates and screws. These structures are placed during open surgery. In adult patients, titanium plates and screws are usually used; in children, materials that can resorb on their own over time are used.

Titanium is a strong metal that securely holds bone fragments in place and does not interact in any way with the human body’s tissues. Titanium fixings can be removed after a few months when the bones have healed. Sometimes, they are left in place to avoid a second surgery. The fixtures may be removed if the patient complains of pain or cold sensation caused by them or if the implants can be detected by touch under the skin (e.g., in the periocular area). Also, although MRI scans can be performed with titanium implants (titanium does not have magnetic properties), they can impair the quality of the image. For this reason, it is sometimes necessary to remove the constructs before performing examinations.

With proper bone fixation, the recovery period is usually relatively painless. The greatest discomfort may be caused not by pain but by postoperative swelling and subcutaneous hemorrhages. These symptoms usually disappear on their own 10-14 days after the intervention. When treating injuries of the lower and upper jaws, fixing them may be necessary, making it difficult to eat. In this case, patients are prescribed a soft dish diet that does not require chewing for 2-6 weeks. After surgery for nasal fracture with or without displacement, a plastic splint may be placed on the patient’s nose, and the nostrils may be closed with tampons. These devices sometimes have to be worn for a week.

There are also methods of treating damaged facial bones without surgical incisions. However, it is not always possible to use them. For example, you can try to fix the bones in an isolated fracture of the nose or cheekbones. However, if the doctor doubts the success of this type of treatment, he will recommend open surgery.

In case of bone loss or irreversible destruction of its fragments in the acute period of craniofacial trauma, reconstructive surgeries allow for the avoidance of repeated operations aimed at the plasticization of the bones of the facial skeleton and reduce the treatment period. In the case of bone tissue defects, according to the indications, various methods of plastic reconstructive surgery are applied. Repair is performed with autografts (including from fragments of damaged bone or intact parts of the skull bones) and/or allografts (organic materials, titanium).

All these treatment options are available in more than 450 hospitals worldwide (https://doctor.global/results/diseases/craniofacial-injury). For example, Craniofacial surgery can be done in 22 clinics across Turkey for an approximate price of $5.5 K (https://doctor.global/results/asia/turkey/all-cities/all-specializations/procedures/craniofacial-surgery). 

Prognosis

Timely, complete diagnosis and surgical treatment can prevent possible complications, restore the anatomy and function of the masticatory apparatus, upper respiratory tract, oculomotor apparatus, and temporomandibular joints, and improve the patient’s aesthetic appearance.