Facial Trauma Treatments Frequently Asked Questions - Houston, TX

What Dental Injuries are Treated by an Oral Surgeon?

We commonly treat fractures of the entire facial skeleton including the frontal bone (forehead), orbits (eye sockets), cheekbones, and nose, as well as fractures of the maxilla and mandible (the upper and lower jaws). Lacerations (cuts) to the scalp, face, ears, and the neck often occur in conjunction with these injuries and they are best repaired at the same time. Injuries to the oral structures (teeth, gums, and tongue) are common as well, and while some can be addressed by your dentist, most will likely be repaired by an oral and maxillofacial surgeon. In short, essentially all non-neurological injuries to the face are within our expertise and scope of practice.

How Can I Tell if My Injury is serious and Should be Evaluated by an Oral Surgeon?

If you have been injured and you have any doubt about the need to seek medical care, you should consult with a caregiver to at least help you assess the seriousness of your injuries. Anytime there has been a loss of consciousness following head trauma, no matter how brief, you should consult with an emergency care facility or your physician. If you have suffered a facial injury and there is a noticeable change in your appearance, eyesight, breathing, occlusion (bite), swallowing, or speaking you should seek medical care. Frequently, fractures to bones of the face are accompanied by subtle changes. Double vision, visual blurriness, pain behind the eye may represent a fracture to the orbit (eye socket) and/or cheekbone. The sensation of teeth being out or loose or that the occlusion (bite) is off often indicates a fracture of the upper or lower jaw. Numbness or tingling to the skin of the face and lips can also point to a significant injury. In short, if you feel that something unusual is happening, you should at least seek consultation with a professional to evaluate the seriousness of the injury.

What Do I Do if My Tooth Gets Knocked Out or Becomes Loose?

This is a common injury. If the teeth have been knocked completely out, remember that in terms of the survival of the teeth, time is of the essence. Try to find the teeth, rinse them with some plain, cool water without scrubbing them and place them in one of the following places:

1) The tooth or teeth should ideally be gently but firmly placed back in their sockets as this is the most physiologic environment.

2) Alternatives include cold milk, saline, or water.

3) In the mouth, under the tongue may be a suitable choice if the patient is awake and alert. Contact us and we will try to treat you as soon as possible.

Often times, the teeth can be reimplanted and splinted or braced to the neighboring teeth and they will survive. Sometimes, the bone that holds the teeth (alveolar process) is also fractured and needs to be stabilized with a type of wire similar to orthodontic braces. If the teeth have been loosened but not avulsed (knocked out) and your bite feels off, these teeth may be repositioned and splinted for proper healing. Under most circumstances, this type of injury can be treated with excellent results, and assuming they are reimplanted quickly, most teeth can be saved. The majority of avulsed teeth will also need endodontic (root canal) therapy to prevent their loss after the initial healing period. Remember that the time the tooth is out of its socket is the most critical factor in determining its eventual survival or loss. When the time out of the socket exceeds two hours, most will not survive even with aggressive treatment. If the teeth do not survive, they can be replaced by implants and new teeth fabricated to replace those lost. If you have such an injury, call us or your dentist immediately so that care may be rendered in a timely fashion.

If I Break My Jaw Will It Need to be Wired Shut?

Most likely not. Most of the fractures of the bones of the face can be treated with very small titanium plates and screws that allow for the bones to heal without the need for limitation of jaw movement. As far as the jaws are involved, the fracture can be immobilized with these plates and screws. The fracture heals by being held in place by the plates, and the patient can continue to function without the drawback of having the teeth wired together. If the fractures are very unstable, the patient may need to have the jaws wired together for a short period of time. There are some particular types of fractures where the option of a short period of intermaxillary fixation (being wired shut), typically 7-10 days, results in a better outcome than the alternative of rigid bone plate fixation without the need for open surgery. Your doctor will discuss all of these alternatives with you at the time of your consultation and afford you an opportunity to make an informed decision about your treatment.

Will There be Any Scars on My Face After My Oral Surgery Procedure?

State-of-the-art techniques used by oral surgeons to repair facial fractures allow us to reach most facial fractures, using no skin incisions. By placing incisions inside the mouth or inside the lower eyelid, for example, most jaw, cheekbone, and orbital fractures can be repaired without incisions on the face. Occasionally, the severity of the injury necessitates a skin incision. These are generally placed in a skin fold under the jaw or behind the hairline to camouflage them and once healed are nearly imperceptible. If the patient or the surgeon notices an unsatisfactory scar, this can be improved by scar revision techniques that include laser surgery.

When Can I Return to Work After a Serious Facial Injury?

Most patients that have sustained serious facial injury can anticipate a 1-to-3-day hospitalization period followed by a few more days of convalescence at home. Depending on one's occupation, most patients can return to work in a week or less. There may still be residual bruising and swelling, but most patients feel well enough to work by a week after repair, barring further disability.

What About Complications from the Oral Treatment of my Fractures?

Traumatic injuries to the face, appropriately treated, generally heal quite well. Although complications are rare, they can occur with any type of treatment. Fractures involving the orbits often produce diplopia (double vision) as a consequence of the traumatic changes to the bones surrounding the eye. Treatment is generally directed to remediating these changes, but rarely, visual changes can persist after initial treatment, necessitating further care. Likewise, numbness to the skin of the cheek or lips is often a consequence of facial fractures and may persist even after surgery. Fractures of the jaws can lead to changes in the bite that may require braces to correct, TMJ pain and dysfunction, loss of teeth, and numbness to the lips and tongue. With our current knowledge and surgical experience, the treatment of facial, jaw, and dental fractures is safe, predictable, and provides excellent results for most patients.

Where Can I Go to be Evaluated for My Facial Injuries?

That depends. If the injury is severe or it has caused you to become unconscious, you should be evaluated in one of the local emergency rooms. Our doctors are on staff at several of the local hospitals and can be called to evaluate you in the hospital. If the injury is less severe, you can contact our oral surgery office and we can evaluate and usually treat you in our oral surgery office. Our Houston oral surgery offices are equipped to provide care for a wide range of injuries to the face and jaws and we can provide care for patients that includes repair of lacerations, stabilization of loose teeth, fixation of broken jaws, and the treatment of other injuries. These treatments can be performed under general anesthesia for painless surgery. Dr. Weil and Dr. Koo are qualified to provide outpatient anesthesia, analgesia, and state-of-the-art treatment of injuries of the face, jaws, and teeth. If you or someone you know has sustained a significant injury that involves the face, the jaws, or the teeth, please contact us for a consultation.