SURGICAL PROCEDURES

Facial Fractures

Overview

A facial fracture is a sudden break in one of the facial bones due to an injury, sports-related accident, physical assault or car crash. Some of these breaks that affect daily living, such as eating, speaking and breathing, require surgical intervention immediately.

Contact your doctor urgently if you suspect a facial fracture. Signs of facial fractures include:

For breaks in the bones of the nose:

  • Purple colouring over the skin of the nose
  • Discoloured eyes (black beneath the eyes)
  • Deviated septum
  • Twisted/disfigured nose
  • Bleeding from the nose

For orbital fractures, signs include:

  • Diplopia (double vision)
  • Trouble moving the eyes
  • Flattened cheeks
  • Protruding or sunken eyeballs
  • Numbness in the face
  • Bloodiness in the whites of the eyes

For jaw fractures (both the lower and upper part of the jaw), symptoms include:

  • Difficulty chewing, speaking and eating
  • Chipped or missing teeth
  • Pain inside the cheeks

Procedure

Plastic and reconstructive surgery aims to correct bone and soft tissues that become damaged due to a traumatic injury. Surgery is done to preserve the orbital cavity, nose and mandible, including the midface. In addition, the eyelids and nerves that control sensation in the face are also impacted.

The plastic and reconstructive surgeon works alongside the orthopaedic surgeon to treat facial fractures through closed or open reduction. A closed reduction is a technique that reduces the broken piece of bone without creating an incision in the skin. By placing the bones back in position, the pieces can heal, unifying simultaneously. A closed reduction is most effective if done directly after the injury.

An open reduction is more invasive because an incision needs to be made to access the broken bones, realigning the pieces correctly. Reconstructive surgery is required when several broken bones are found in the facial region.

Imaging studies have evolved and include the use of CT scans, x-rays and 3D reconstructions that help rebuild the area and repair broken bones.

For example, zygoma fractures are due to blunt force trauma to the zygomatic bone, an irregularly shaped bone that contours the face's front and flanking portions. Treatment of a complex facial fracture like the zygomatic fracture (cheekbone fracture) involves first immobilising the site. Then, incisions are made in specific regions such as inside the mouth, eyelid and eyebrow. However, Dr Kleintjes creates incisions posteriorly behind the hairline for complex fractures.

Dr Kleintjes works with other specialists, including those specialising in orthopaedics and neurosurgery, to stabilise the fracture, preventing movement of the bones. Those with facial trauma, cheekbone fractures and facial injuries need to contact Dr Kleintjes, who is a facial trauma specialist specialising in the restoration of the face.

Recovery

Reconstructive surgery can take place in the doctor’s rooms or hospital, depending on the extent of the injury and damage to the facial nerves and bones. Specific post-operative instructions are provided to protect the anatomy of the face. For instance, avoiding certain activities is essential in the recovery process. It helps to attend follow-ups regularly to ensure you are healing well.

FAQ

1What types of reconstructive procedures are used to treat facial fractures?
To rebuild parts of the face, Dr Kleintjes utilises a free flap whereby muscle, bone and skin are taken from a healthy part of the body and used to create facial components. This is referred to as a microvascular free flap because blood vessels are already attached to the transplanted tissue but must still be reattached to a new blood supply. In some cases, facial prosthetics and implants are used when the fracture is complex, and the bones and surrounding tissue damage is severe.
2What are facial reconstructive procedures?
When damage is severe, possible reconstructive options include the following:
  • Remodelling of the head, face and neck after cancer surgery
  • Reconstruction of the nose involves creating incisions inside the nose or between the nostrils through which the plastic surgeon creates tissue flaps. The flaps are then used to remodel the nasal cartilage, bone or both cartilage and bone.
  • Cleft lip and palate repair are two different surgery stages that seal the gap at the top of the mouth and the lip's slit to improve speaking and eating.
  • Reconstruction of the ear or otoplastyis surgery to correct the structure of the ears due to a traumatic injury, congenital abnormality or cancer.
  • Facial reanimation restores sensations in your face that could be lost due to nerve damage. Facial reanimation improves your facial expressions, particularly after suffering facial paralysis.
  • Mohs surgery is a procedure to remove a tumour on the skin’s surface. Afterwards, reconstruction of that particular region of the skin is needed.
3How is 3D printing used in facial reconstructive surgery?
3D technology can be used in craniomaxillofacial procedures to adapt the anatomy of the face, bones and jaw.

REQUEST AN APPOINTMENT