Correction of Jaw and Facial Fractures

The chin and face are the most vulnerable parts of the body to trauma. Injuries to both soft tissue and bones often occur in this area due to traffic accidents, beatings and falls. In this region, when viewed from above; frontal bone (forehead bone), eyeball bones (orbita), zygoma and arch (cheekbone and extension), maxilla (upper jawbone) and mandible (lower jawbone). Fractures of each of these bones have distinct clinical scenarios and require different treatment. After the trauma, the patient should be examined by the plastic surgeon as soon as possible and the fracture should be evaluated with the appropriate imaging method. Computed tomography (CT) is used as the gold standard examination method in fractures of this region (Exception: Panoramic film in the lower jaw is considered superior to CT). In maxillofacial fractures, the presence of the fracture, as well as the displacedness that can cause problems, and the occurrence of problems in vital functions, especially vision and chewing, are extremely important in terms of making the decision for surgery.

 

Frontal bone (forehead bone) fractures usually occur after high-energy trauma and often the patient has additional medical problems. In fractures involving only the outer layer of the frontal bone and distorting the image in the forehead region, the bone is corrected through an incision made through the hair and fixed with titanium plate screws. If there is a multi-part fracture that includes the inner layer of the bone and cannot be corrected, the operation is performed together with neurosurgery, the inner part of the bone is removed and, if necessary, the outer part is reshaped.

 

In orbital fractures, the most important factor that makes the decision for surgery is the changes related to the eye. Any change in the visual function of the person, especially double vision and limitation of gaze, is counted as an absolute reason for surgery. In the surgery of these fractures, the walls of the eyeball are reached by entering through incisions made through the eyelids. After the broken part is corrected, if there is no deficiency in the bone, fixation is applied with titanium plate screws. If there is a bone deficiency, especially at the base of the eyeball, the deficiency is completed with the help of bone patches (bone grafts) taken from the body and substances called medpor.

 

Cheekbone (zygoma) fractures are basically divided into two as fractures of the main body of the bone or its extension towards the front of the ear (zygoma arch). In arch fractures, there are two main findings that make the decision for surgery; The first of these is the limitation of the mouth opening, and the second is the collapse in that area. In this case, under local anesthesia and sedative medication (general anesthesia is often not needed), the arc is taken to its correct place by entering through an incision of approximately 2 cm through the hair. A more comprehensive surgery should be performed in fractures of the main body of the cheekbone. In this surgery, the bone is brought to its correct position by entering through the eyelid and mouth and fixed with titanium plate screws at 2 or 3 points.

 

Upper jaw (maxilla) fractures are divided into three according to the line where the fracture line passes (LeFort-1,2 and 3). The most important factor that directs us to surgery in the treatment of these fractures is that they cause disorders in the bite. In the treatment of maxillary fractures, the surgical incision is made through the mouth and the bone is fixed with titanium plate screws, taking into account the harmony of the upper jaw and lower jaw. After this surgery, the upper and lower jaws are tied together with elastic bands for 2-3 weeks, and the jaw is healed with a correct closure.

 

Treatment of lower jaw (mandible) fractures differs according to the site of the fracture or fractures. Surgical treatment of fractures close to the jaw joint is usually followed by connecting the jaws to each other with rubber bands, since it is more difficult to reach the area (the nerve that provides facial movements, called the facial nerve, passes in front of the ear, close to the jaw joint), but if this method cannot be treated, the jaw can be treated. The plate is fixed with screws by making an incision below and in front of the ear. Generally, except for fractures close to the jaw joint, the broken segments are taken to their correct place by incisions made through the mouth and fixed with titanium plate screws. After this surgery, the upper and lower jaws are connected with elastic bands for 2-3 weeks, and the jaw is healed with a correct closure.

 

Bone fractures in the jaw and face are serious injuries that may require treatment with complex surgical procedures and have a long-term risk of sequelae. After the first treatment in the emergency is completed, the patients should be followed up and treated with a plastic surgeon without losing time.