Maxillofacial Injury

Maxillofacial injury is injury to the facial soft tissues, facial skeleton and associated specialised soft tissues within the head and neck as a result of wounding or external violence. The Oral & Maxillofacial Surgeon is an essential part of comprehensive Accident & Emergency Services in the management of these injuries, both primary and secondary. In the more severe injuries, the OMF Surgeon works in close collaboration with many other specialities, in particular neurosurgical and ophthalmological colleagues.

Incidence

A population of 500,000 yields in excess of 4,000 facial injuries per year, of which 250 will be facial fractures, excluding simple nasal fractures. The incidence of facial fractures continues to rise. In the United Kingdom, the major cause of trauma to the facial area is inter-personal violence, with the incidence of injuries from road traffic accidents showing a decline in recent years. This may be a reflection of the effectiveness of seatbelt legislation, improved car design and safety equipment, and improvements in pre-hospital care and rapid patient transfer to trauma-accredited hospitals. This has lead to an increase in the number of patients arriving at hospital with multi-system trauma and severe facial injuries.

A national facial injury survey, conducted by BAOMS in 163 Accident & Emergency Departments across the United Kingdom, identified in one week 6,114 patients who presented with facial injuries. This study found that :

• nearly a quarter of facial injuries in all age groups were associated with
  alcohol consumption
• one in three of these had serious facial injuries requiring specialist treatment
  or hospital admission
• at least half a million facial injuries occur in the United Kingdom annually and
  180,000 are of a serious nature
• assault was the cause of 25% of facial injuries, ie. at least 125,000 facial
  injuries per year are caused by assault
• 40% of assaults caused serious facial injuries
• 51% of assault victims had drunk alcohol within 4 hours of the injury
• 40% of all the assaults occurred in the 15-25 age group and more than 40%
  of these caused serious facial injury
• more women than men were assaulted in the home, nearly half of all assaults
  on women occurred in the home. Overall, however, 4 men were assaulted
  for every assault on a woman.
• road traffic accidents caused 5% of facial injuries, but more than 40% of these
  resulted in serious facial injury
• 1 in 6 patients involved in road traffic accidents had drunk alcohol within four
  hours of the injury
• 10% of patients with facial injuries caused by falls had drunk alcohol within
  four hours of the injury

These findings confirm that facial injury has a major impact on the provision of Accident & Emergency Services and the essential role the oral and maxillofacial surgeon has in managing these patients.

Management

Advanced Trauma Life Support (ATLS) to accident victims is delivered by a multi-disciplinary team and trainees in oral & maxillofacial surgery are expected to have successfully completed the ATLS Course. The skeletal and soft tissue anatomy of the craniofacial region is complex and a specialist knowledge of the oral cavity, both anatomically and functionally, is essential for successful management of patients with facial injury.

Injuries to the maxillofacial area are routinely treated by the technique of open reduction and internal fixation, using a variety of micro, mini and reconstruction plating systems. This has lead to early restoration of function and rapid rehabilitation, but there is no doubt that many serious facial injuries can cause permanent facial disfigurement and psychological distress with extensive soft tissue scarring presenting a particular challenge to the oral & maxillofacial surgeon.

In collaboration with neurosurgical colleagues, it has now become possible for simultaneous management of severe craniomaxillofacial trauma to be dealt with in a single stage, often using a shared surgical access. The use of advanced imaging techniques such as CT scan, MRI and Stereolithography are used to demonstrate the pattern of cranial and facial bony injuries and to plan better primary treatment. Modern oral & maxillofacial surgical techniques have resulted in early restoration of function and return to work and have reduced the need for secondary reconstruction and scar revisions. It is essential that all facial injuries are referred to the oral & maxillofacial surgeon.