In modern post graduate surgical training programs, facial trauma responsibilities are divided between Oral and Maxillofacial, Plastic and Reconstructive, and Otolaryngology/Head and Neck surgical services. Consequently, trainees in all three surgical disciplines learn how to treat and care for a wide variety of facial injuries. In the private practice setting, at the local hospital, who takes care of the facial trauma patient varies by community and with surgical specialty availability. In our community, Mission Hospital Regional Medical Center is one of 3 trauma centers in Orange County, and has been so designated since the 1970’s. If you are a facial trauma patient in South Orange County, you will likely be treated at Mission Hospital.
Our Oral and Maxillofacial Surgery (OMS) group takes care of facial trauma patients at Mission Hospital and has been doing so for 40 years. Care for these patients is also provided by the Plastic and Reconstructive Surgery (PRS) service and other community Oral and Maxillofacial surgeons. When a patient has complex facial injuries including several anatomic regions of the face, surgical repair is often performed jointly with both OMS and PRS surgeons in attendance. OMS surgeons have particular expertise in the repair of lower jaw, (mandible) midface (maxilla) and dental injuries. Areas of crossover training with PRS include the management of cheekbone (zygoma), nose (nasal) and eye socket (orbital) fractures. If eye or ear injuries are present, typically the patient will also be managed by an Ophthalmologist (eye surgeon) or Otolaryngologist (ENT). All surgeons who train in facial trauma management learn how to perform soft tissue wound repair utilizing fine-suture plastic surgery techniques.
When facial bone fractures are present as the result of trauma, bone healing principles are similar to those of orthopedic surgery. Generally, 6 weeks of immobilization is required for bone healing to be sufficient enough to begin to return to function. Immobilization of facial bone fractures can include internal fixation devices and fastening the jaws together allow complete healing. If the jaws are immobilized, chewing cannot occur and the diet is limited to blenderized foods. This unpleasant consequence of midface or lower jaw fracture is maintained the minimum amount of time necessary for healing. Temporary weight loss is not uncommon during a period of jaw immobilization. If teeth are damaged or lost as part of the facial injury, modern restorative dental techniques, combined with placement of dental implants can return the patient to normal appearance and function. When facial bone fractures are present as the result of trauma, bone healing principles are similar to those of orthopedic surgery.