Trauma & Reconstruction Surgery

A fracture is a broken bone. Facial fracture refers to any injury that results in a broken bone or bones of the face.

Facial Fracture Symptoms:

Although certain symptoms are specific for the bone fractured, some symptoms are common to any fractured bone. Remember that these symptoms may indicate a soft tissue injury (without a broken bone).

• Pain
• Swelling
• Bruising

Broken Nose Symptoms:

• Swelling
• Tenderness
• Deformity
• Nosebleed (if present, is usually minor)
• Significant trauma to the bridge of the nose may result in a fracture of the bones inside the nose (ethmoid bones).
• These bones, if fractured, may cause the brain to connect with the outside environment.
• Possible symptoms include persistent nosebleed or a clear nasal discharge.

Broken Jaw Symptoms:

• Jaw pain
• Tenderness
• Inability to bring the teeth together properly (malocclusion)
• Bruising under the tongue almost always indicates a jaw fracture.

Midface (Maxillary) Fracture Symptoms:

• Inability to bring the teeth together properly
• Visual problems
• Clear nasal discharge
• Bruising may be present around the eyes and the midface may be able to be moved.
• These fractures are not usually subtle and are often the result of high-speed car accidents. As a result, there might be severe injury to areas other than the face.
• Many of these people will have difficulty breathing and require a tube to be placed down their throat to help them breathe.

Cheekbone (Zygomatic) Fracture Symptoms:

• Flatness of the cheek
• Altered sensation underneath the eye on the affected side
• Visual complaints
• Pain with jaw movement
• Blood in the side of the eye on the affected side sometimes is present.

Eye Socket (Orbital) Fracture Symptoms:

• Sunken eye (enophthalmos)
• Altered sensation beneath the affected eye
• Double vision, particularly with upward gaze
• This fracture involves the bones of the eye socket.
• Injury usually occurs when a blunt object hits the eye such as a fist or a ball.

Temporomandibular Joint (TMJ) Dislocation Symptoms:

• Jaw deviation
• Inability to close the mouth
• Dislocation of the TMJ (the joint where your jaw meets with the temporal bone, in front of the ear) can occur with blunt trauma, seizures, or excessive mouth opening.
• A doctor should check all people with facial trauma and any significant facial injury. The affected individual can either see a doctor or go to the emergency department.

If a person experiences the following symptoms, seek medical attention:

• Clear nasal discharge
• Nosebleed
• Loss of consciousness
• Any visual disturbance such as double or blurry vision
• Any hearing problem
• Inability to bring teeth together
• Pain with jaw movement
• Altered sensation on the face
• Face uneven (asymmetrical)
• Open wounds with visible bone

Corrective jaw, or orthognathic, surgery is performed by Oral and Maxillofacial Surgeons to correct a wide range of minor and major skeletal and dental irregularities, including the misalignment of jaws and teeth, which, in turn, can improve chewing, speaking and breathing. While the patient's appearance may be dramatically enhanced as a result of their surgery, orthognathic surgery is performed to correct functional problems.

Following are some of the conditions that may indicate the need for corrective jaw surgery:

• Difficulty chewing, or biting food
• Difficulty swallowing
• Chronic jaw or jaw joint (TMJ) pain and headache
• Excessive wear of the teeth
• Open bite (space between the upper and lower teeth when the mouth is closed)
• Unbalanced facial appearance from the front, or side
• Facial injury or birth defects
• Receding chin
• Protruding jaw
• Inability to make the lips meet without straining
• Chronic mouth breathing and dry mouth
• Sleep apnea (breathing problems when sleeping, including snoring)

Who Needs Corrective Jaw Surgery?
People who may benefit from corrective jaw surgery include those with an improper bite resulting from misaligned teeth and/or jaws. In some cases, the upper and lower jaws may grow at different rates. Injuries and birth defects may also affect jaw alignment. While orthodontics can usually correct bite, or "occlusion," problems when only the teeth are misaligned, corrective jaw surgery may be necessary to correct misalignment of the jaws.

Evaluating Your Need for Corrective Jaw Surgery
Your dentist, orthodontist and Oral and Maxillofacial Surgeon will work together to determine whether you are a candidate for corrective jaw, or orthognathic, surgery. The Oral and Maxillofacial Surgeon determines which corrective jaw surgical procedure is appropriate and performs the actual surgery. It is important to understand that your treatment, which will probably include orthodontics before and after surgery, may take several years to complete. Your Oral and Maxillofacial Surgeon and orthodontist understand that this is a long-term commitment for you and your family.They will try to realistically estimate the time required for your treatment.

Corrective jaw surgery may reposition all or part of the upper jaw, lower jaw and chin. When you are fully informed about your case and your treatment options, you and your dental team will determine the course of treatment that is best for you.

The orbit is the boney socket in your skull that contains and houses the eye and all the associated structures that support the function of the eye like muscles, nerves and blood vessels. The eye and these other structures are surrounded by fat which acts as cushion to protect the eye as we run around or if we inadvertently get hit in the eye. Unfortunately, a variety of problems can occur in the eye socket that effect the function of the eye. These processes range from inflammatory disease like thyroid associated orbitopathy as seen in patients with Graves’ disease to tumors, infections, and injuries from trauma. When these problems occur, patients often have double vision, loss of vision, pain and swelling. Evaluation with a board certified surgeon is important to appropriately evaluate and treat the underlying problem.

Nasal reconstruction repairs nasal deformities due to trauma, cancer, and malformed or missing nasal anatomy. It is most commonly done after nasal injuries.

Who is an Ideal Candidate?
People with:

• Nasal deformities due to fracture or other injury.
• Nasal deformities due to skin cancer removal.

Cleft lip and cleft palate are facial and oral malformations that occur very early in pregnancy, while the baby is developing inside its mother. Clefting results when there is not enough tissue in the mouth or lip area, and the tissue that is available does not join together properly.

A cleft lip is a physical split or separation of the two sides of the upper lip and appears as a narrow opening or gap in the skin of the upper lip. This separation often extends beyond the base of the nose and includes the bones of the upper jaw and/or upper gum.

A cleft palate is a split or opening in the roof of the mouth. A cleft palate can involve the hard palate (the bony front portion of the roof of the mouth), and/or the soft palate (the soft back portion of the roof of the mouth).

Cleft lip and cleft palate can occur on one or both sides of the mouth. Because the lip and the palate develop separately, it is possible to have a cleft lip without a cleft palate, a cleft palate without a cleft lip, or both a cleft lip and cleft palate together.

Who Gets Cleft Lip and Cleft Palate?
Cleft lip, with or without cleft palate, affects one in 700 babies annually, and is the fourth most common birth defect in the U.S. Clefts occur more often in children of Asian, Latino, or Native American descent. Compared with girls, twice as many boys have a cleft lip, both with and without a cleft palate. However, compared with boys, twice as many girls have cleft palate without a cleft lip.

What Causes a Cleft Lip and Cleft Palate?
In most cases, the cause of cleft lip and cleft palate is unknown. These conditions cannot be prevented. Most scientists believe clefts are due to a combination of genetic and environmental factors. There appears to be a greater chance of clefting in a newborn if a sibling, parent, or relative has had the problem.

Another potential cause may be related to a medication a mother may have taken during her pregnancy. Some drugs may cause cleft lip and cleft palate. Among them: anti-seizure/anticonvulsant medications, acne medications containing Accutane, and methotrexate, a drug commonly used for treating cancer, arthritis, and psoriasis.

Cleft lip and cleft palate may also occur as a result of exposure to viruses or chemicals while the fetus is developing in the womb.

In other situations, cleft lip and cleft palate may be part of another medical condition.

What's the Treatment for Cleft Lip and Cleft Palate?
A cleft lip may require one or two surgeries depending on the extent of the repair needed. The initial surgery is usually performed by the time a baby is 3 months old.Repair of a cleft palate often requires multiple surgeries over the course of 18 years. The first surgery to repair the palate usually occurs when the baby is between 6 and 12 months old. The initial surgery creates a functional palate, reduces the chances that fluid will develop in the middle ears, and aids in the proper development of the teeth and facial bones.

Children with a cleft palate may also need a bone graft when they are about 8 years old to fill in the upper gum line so that it can support permanent teeth and stabilize the upper jaw. About 20% of children with a cleft palate require further surgeries to help improve their speech.

Once the permanent teeth grow in, braces are often needed to straighten the teeth.

Additional surgeries may be performed to improve the appearance of the lip and nose, close openings between the mouth and nose, help breathing, and stabilize and realign the jaw. Final repairs of the scars left by the initial surgery will probably not be performed until adolescence, when the facial structure is more fully developed.

Although treatment for a cleft lip and/or cleft palate may extend over several years and require several surgeries depending upon the involvement, most children affected by this condition can achieve normal appearance, speech, and eating.

We have expertise in cranial base access surgery, working with neurosurgeons to access difficult-to-reach brain and spinal lesions.