Facial Trauma Treatment & Care

We are trained, skilled and uniquely qualified to manage and treat acute injuries to the facial skeleton. We are very fortunate to be an integral part of the trauma team at Hackensack University Medical Center. The Medical Center is recognized nationally for its emergency services and is a state designated Level II Trauma center.

Our emergency room coverage for facial injuries includes:

• Facial lacerations
• Intra oral lacerations
• Avulsed (knocked out) teeth
• Fractured facial bones (cheek, nose, or eye socket)
• Fractured jaws (upper and lower jaw)

Injuries to the face, by their very nature, impart a high degree of emotional and physical trauma to many of our patients. The art and science of treating facial injuries requires special training involving “hands on” experience. The doctors and staff have an intimate and an understanding of how the treatment we provide will influence our patient’s long-term function and appearance.

The Nature of Maxillofacial Trauma
There are a number of possible causes of facial trauma. Motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work related injuries. Facial injuries can range from injuries to the teeth, to extremely severe injuries of the skin and bones of the face. Typically, facial injuries are classified as soft tissue (skin and gums), bony (fractures), or injuries to special regions (such as the eyes, facial nerves or the salivary glands).

Soft Tissue Injuries of the Maxillofacial Region
When soft tissue injuries such as lacerations occur on the face, they are repaired by suturing. In addition to the obvious concern of providing primary repair which will yield the best cosmetic result possible, care must be taken to inspect for and treat injuries to specialized structures such as facial nerves, salivary glands and salivary ducts (or outflow channels for saliva).

Bone Injuries of the Maxillofacial Region
Fractures of the facial bones are treated in a manner similar to fractures in other parts of the body. The specific form of treatment is determined by various factors which include the location of the fracture, the severity of the fracture, the age and general health of the patient. When an arm or a leg is fractured, a cast is often applied to stabilize the bone to allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial bone fractures.

One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. Certain types of fractures of the jaw are best treated and stabilized by the surgical placement of small plates and screws at the involved fracture site. This technique is called “rigid skeletal fixation”. The relatively recent development and use of rigid fixation has profoundly improved the recovery period for many of our patients, allowing them to return to normal function more quickly.

The treatment of facial fractures should be accomplished in a thorough and predictable manner. More importantly, the patient’s facial appearance should be minimally affected. An attempt at accessing the facial bones through the fewest incisions necessary is always considered during fracture repair. The incisions that become necessary are designed to be small and, whenever possible, are placed so that the resultant scar is minimal.

Injuries to the Teeth and Surrounding Dental Structures
Isolated injuries to teeth are common and may require the expertise of various dental specialists. Oral surgeons commonly are involved in treating fractures of the supporting bone or in re-implanting teeth which have been displaced or knocked out. These types of injuries are treated by one of a number of techniques of splinting teeth (stabilizing by wiring or bonding teeth together). If a tooth is avulsed (knocked out), it is best to have it re-implanted as soon as possible after the accident. The sooner the tooth is re-inserted into the dental socket, the better chance it will survive. If immediate replacement is not possible the tooth should be placed in salt water or milk and be subject to minimal handling. Never attempt to wipe the tooth off, since remnants of the specialized dental ligament which hold the tooth in the jaw are attached. This ligament is vital to the success of re-implanting the tooth. In the event that injured teeth cannot be saved or repaired, dental implants are often now utilized as replacements for missing teeth.

Trauma Prevention
Maxillofacial injuries, or facial trauma, refer to any injury to the mouth, face, and jaw.

In more severe cases a person may be rendered unconscious, disoriented, nauseated, dizzy or otherwise incapacitated. In these cases immediate medical attention is required and you should call 911 immediately. Do not attempt to move the individual yourself. If these symptoms are not present and the injury is severe or you are uncertain about its severity, you can contact our office. As Oral and Maxillofacial surgeons we are the specialty most suited to diagnosis and treat injuries to the teeth, mouth, jaws and facial structures.

While not all facial injuries are extensive, they are all complex since they affect an area of the body that is critical to breathing, eating, speaking and seeing. A good rule of thumb is not to take any facial injury lightly. It is virtually impossible to prevent maxillofacial injuries in today’s active society, however it is possible to protect ourselves from some of the more common causes of maxillofacial injuries and prevention with regards to oral facial injuries is always desired. We are strong advocates of the use of all protective measures available such as automobile harnesses, protective mouth guards, and appropriate masks and helmets for those who participate in athletics at any level.

Sports injuries are a leading cause of maxillofacial injuries and can be greatly reduced with the aid of a properly fitted athletic mouthguard. You don’t have to play at the professional level to sustain a serious maxillofacial injury. Make sure your family is well protected. If you participate in sports at any level, we strongly advise that you make the following safety gear a part of your standard athletic equipment:

• Football: Helmets with face guards and mouth guards should be worn. Many of the helmets manufactured for younger players have plastic face guards that can be bent back into the face and cause injury. These should be replaced by carbon steel wire guards.
• Baseball: A catcher should always wear a mask. Batting helmets with a clear molded plastic face guard are now available; these can also be worn while fielding.
• Ice Hockey: Many ice hockey players are beginning to wear cage-like face guards attached to their helmets. These are superior to the hard plastic face masks worn by some goalies, as the face guard and the helmet take the pressure of a blow instead of the face. For extra protection, both face and mouth guards — including custom mouth guards and secured with straps — should be worn.
• Wrestling: More and more high school athletic associations require wrestlers to wear head gear. A strap with a chin cup holds the gear in place and helps steady the jaw. Recently, face masks have been developed for wrestlers, who should also wear mouth guards.
• Boxing: Mouth guards are mandatory in this sport. A new pacifier-like mouth guard for boxers has been designed with a thicker front, including air holes to aid breathing.
• Lacrosse: Hard plastic helmets resembling baseball batting helmets, with wire cage face masks, are manufactured for this sport.
• Field Hockey: Oral and maxillofacial surgeons recommend that athletes participating in this sport wear mouth guards. Goalies can receive extra protection by wearing Lacrosse helmets.
• Soccer: Soccer players should wear mouth guards for protection. Oral and maxillofacial surgeons advise goalies to also wear helmets.
• Biking: All riders should wear lightweight bike helmets to protect their heads. Scooters and Skateboarders: Bike helmets are also recommended for those who ride two-wheeled scooters and skateboards.
• Skiing and Snowboarding: The recent surge in accidents among skiers and snowboarders has encouraged many safety conscious participants to wear lightweight helmets that will protect the maxillofacial area in the event of a fall or crash.
• Horseback Riding: A helmet and mouth guard are recommended for horseback riding, particularly if the rider is traveling cross-country or plans to jump the horse.
• Basketball, Water Polo, Handball, Rugby, Karate, Judo, and Gymnastics: Participants in these sports should be fitted with mouth guards.

Despite the innovations in mouth and face guard technology, many athletes continue to subject themselves to needless sports-related injuries to the mouth and face. Drs. Barbieri, Colameo & Berardo are very active in our communities in encouraging the use of oral and facial protection during athletic competition. We have taken a proactive role with our local schools in promoting their use. New synthetic materials and advances in engineering and design have resulted in mouthguards that are sturdier yet light enough to allow ease of breathing and communication during athletic competition. We recommend that oral mouthguards should be evaluated according to five very important criteria:

• Comfort and retention. They should be comfortable and retentive. It is important they cover the upper teeth and part of the gums to afford maximum protection.
• Proper fit. Mouth guards should be constructed so that they do not misalign the jaws or throw off the bite.
• Light weight. They should be light weight to allow the athlete the ability to speak and breathe
• Strong and durable. Mouth guards should be strong, durable and tear resistant
• Cleansable. Easy to maintain and clean

We encourage you to discuss this very important issue with our doctors.