Craniofacial reconstruction following trauma is different for each individual as it highly depends on the nature and location of the patient's injuries. The first priority in any trauma patients is treating problems with airway, breathing, circulation or any other life-threatening emergency before treating facial injuries. Over 60% of patients with severe facial trauma have other serious injuries in the head, chest, or abdomen. This high rate of additional injuries reflects the enormous forces needed to fracture human facial bones. In particular, a doctor who is examining a patient with severe facial trauma will be particularly concerned about damage to the brain, the spinal cord in the neck, and the eyes. Of note, severe facial trauma often leads to blockage of the airway thus it is important to have a protected airway before continuing trauma resuscitation and treatment of facial injuries. The second priority in treating traumatic facial injuries is controlling severe bleeding.
Imaging studies of craniofacial injuries may need to be postponed for 24-72 hours in order to treat injuries to other organ systems. When the patient is out of immediate danger, x-ray studies and computed tomography (CT) scans are taken of the craniofacial injuries. The accurate diagnosis of facial fractures has been greatly improved by the addition of two- and three-dimensional CT scans which have replaced the plain x-rays for the diagnosis of many types of fractures. Three-dimensional reconstructions have enhanced preoperative bone analysis and planning for reconstructive surgery by providing a life-like simulation of the fractures.
The best way to prevent post-traumatic facial deformities is to obtain the appropriate treatment at the time of the injury. Delayed treatment has been replaced by early or immediate surgical treatment and stabilization of small bone fragments augmented by bone grafts and mini-plate fixation. These new advances have allowed surgeons to approach and often reach the goal of restoring pre-injury facial appearance and function in a one-stage operative repair. However, despite many surgical advances, there are still patients that end up with significant deformities. These are patients that for whatever reason are treated inadequately or because of other life-threatening injuries, cannot receive treatment of their facial injuries.
Surgery following facial trauma may take as long as four to 14 hours, as the goal is to repair as much as possible in one operation. The surgeon may use bone grafts, taking bone from other parts of the body to repair the facial bones, or fill in smaller areas of missing bone with prosthetic materials and implants. Broken facial bones are held in place with titanium mini-plates and surgical screws. This technique is called rigid fixation. Lacerations (tears) in the face are usually simply closed with stitches. If large areas of skin are missing, the surgeon may use a flap, which is a section of living tissue carrying its own blood supply, from another area of the patient's body and transplant it to the face. Some facial injuries may require the assistance of a neurosurgeon, oral surgeon, or ophthalmologist. More Facial Trauma & Facial Reconstructive Surgery Facts...
To repair severe fractures around the nasal bone (A), an incision is made into the patient's skin at the top of the head (B). The skin is pulled off the face to expose the fracture (C), which then can be repaired with plates and screws (D). (Illustration by GGS Inc.)
Some of the risks of craniofacial reconstruction are common to all surgical procedures done under general anesthesia. These include bleeding, breathing problems, bruises underneath the skin, reactions to the anesthesia, and infection.
Risks that are specific to craniofacial reconstruction include:
Risk factors that can affect the results of craniofacial reconstruction include:
This information is intended only as an introduction to this procedure. This information should not be used to determine whether you will have the procedure performed nor does it guarantee results of your elective surgery. Further details regarding surgical standards and procedures should be discussed with your physician.