The skull is arguably the most complex area of our skeletal system. It is comprised of 22 bones–8 of which are cranial bones and 14 of which are facial bones. Together the cranial and facial bones protect and support our sensory organs, protect the brain, and provide a scaffolding for muscles. The intricate system of facial bones forms the mechanical framework that allows for the proper movement of the head and face.
The bones that make up the facial skeletal system include: the orbital bones (seven bones that enclose the eye), the nasal bones (two bones that form the bridge of the nose), the turbinate bone (spongy bones of the nasal cavity), the vomer (bone that separates the nasal passages), the zygoma (cheekbone, also known as the malar bone), the maxilla (upper jaw bone), and the mandible (the lower jaw bone).
Facial bones vary in size and strength. The mandible is the largest, sturdiest bone of the face, while the lacrimal bone, an orbital bone that supports the tear duct, is the smallest and most fragile. About the size of a fingernail, the lacrimal bone is, in fact, one the smallest bones in the body.
Fractures can occur on any bone of the face; however, the force it takes to break a facial bone depends on the bone’s strength as well as the speed and the angle of the impact. To help understand the nature of facial bone trauma, it may be helpful to consider the bones by region:
When compared to other bones of the body, nasal bones can be broken relatively easily. The most common facial bone trauma, nasal fractures account for up to 45% of all facial fractures.
Signs of nasal fractures: Swelling, tenderness, nasal deformity, bloody nose. In severe cases, the brain may be exposed to the outside environment.
Often the result of a blunt object hitting eye, orbital fractures can involve both the rim of the eye and the bone that keeps the eye in place. Damage to the eye socket is frequently seen in sports injuries.
Signs of orbital fractures: Tissue swelling and bruising, double vision, sunken eye.
A cheekbone fracture, often referred to as a zygoma fracture, is commonly combined with an orbital fracture. This type of fracture affects the functioning of the jaw and the position of the cheekbone.
Signs of cheekbone fractures: Flattened of the cheek with facial asymmetry, altered sensation around the injured area.
A lower jaw fracture is one of the most distressing facial fractures. Recovery from a mandible fracture can be lengthy and uncomfortable. Jaw trauma may also result in tooth damage and persistent facial numbness. Most commonly this injury results in difficulty and pain when either opening or closing the jaw.
Signs of mandible fractures: Jaw tenderness and pain, inability to bring teeth together and/or chew.
It is important to remember that some symptoms, such as pain, swelling, and bruising are common to all fractures, as well as other soft tissue injuries. If a broken bone is suspected, it is best to seek a medical diagnosis.
Although any type of impact can cause a bone injury, car accidents, sports trauma, falls, and assaults are the most common causes of facial fractures. Nasal and orbital fractures are common among boxers, martial arts fighters, and those participating in contact sports. Severe midface injuries and jaw fractures are often due to automobile crashes.
Before recommending a treatment, it is important to properly diagnose a facial bone fracture. Depending on the area of the face affected, a simple X-ray, a CT scan, or a combination of both may be used.
X-rays are often useful in the initial diagnosis of jaw, orbital, and cheekbone fractures; additionally, they may be used to assess focal injuries (as in the case of a nasal fracture). When more information is needed, a CT scan may be ordered.
A computed tomography (CT) scan shows the detailed anatomy of the facial bones in excellent detail allowing the injury to be evaluated with a greater degree of accuracy.
Just as the facial bones vary, so does the treatment of facial bone fractures. Depending on the nature of the injury, extensive surgical repair may be required. This often involves the placement of titanium plates and screws in order to stabilize the bone. A craniofacial surgeon typically performs surgery on facial bone fractures. Using state-of-the-art technology, surgeon Dr. Robert Morin can comprehensively assess a facial bone injury and determine the appropriate surgical intervention.
Dr. Robert J. Morin is a board certified plastic surgeon who specializes in rhinoplasty and complex facial reconstructive procedures. Highly trained in craniofacial surgery, facial cosmetic surgery, and pediatric plastic surgery, Dr. Morin is a specialist who has helped both adults and children recover from severe facial injuries and congenital deformities. In treating facial fractures, Dr. Morin works with other skilled specialists, such as neurosurgeons and oral surgeons, to restore form and function after trauma.