The Role of Oral Surgery in Treating Facial Trauma

Dr. Lieblick: You’re listening to Oral Surgery Insights. I’m Dr. Russ Lieblick, here with Dr. Brandon Rehrer. Brandon, I was thinking earlier about the different paces of our work. So much of what we do is built on meticulous, long-term planning that unfolds over weeks or months.

Dr. Rehrer: It is. That careful, methodical approach is essential for complex restorative cases like dental implants or full mouth reconstructions. But then there's the other side of our specialty, the part that is completely unplanned, immediate, and requires a totally different mindset.

Dr. Lieblick: The moments when an accident happens, an injury occurs, and our focus shifts in an instant from our scheduled day to an emergency call from the hospital.

Dr. Rehrer: Exactly. And that's the world of facial trauma. It's a core part of what we do, and it’s where our years of hospital-based surgical training are absolutely essential. It’s about taking control in a chaotic situation to help someone through a very sudden and often frightening event.

Dr. Lieblick: It’s a crucial aspect of our commitment to the community, and it's what we want to explore today—how we, as oral and maxillofacial surgeons, manage and repair these complex injuries to restore not just physical structures, but a person’s function and sense of self.

Dr. Rehrer: To start, "facial trauma" is a broad term. It covers a wide spectrum of injuries to the face, mouth, and jaws.

Dr. Lieblick: The causes are unfortunately things that are a part of life: motor vehicle accidents, accidental falls, work-related incidents, sports injuries. These events can result in damage to the soft tissues—the skin, muscles, and nerves—and the hard tissues, which are the teeth and the intricate bones of the facial skeleton.

Dr. Rehrer: This is where the unique training of an oral and maxillofacial surgeon becomes so important. Our specialty is distinct because we have a deep, integrated knowledge of the entire facial anatomy. The face isn't just a collection of bones; it's a functional matrix of bone, muscle, and nerves, all working in concert for expression, speech, and eating. Our training is focused on understanding and managing all of those layers.

Dr. Lieblick: And that’s paired with our foundational understanding of dentistry and how the teeth must fit together—what we call the dental occlusion. That dual expertise is absolutely critical. Treating a broken jaw, for instance, isn't just about getting the bone to heal.

Dr. Rehrer: Not at all. It must heal in the exact pre-injury position so that the person's bite is correct again. If the occlusion is off by even a millimeter, it requires even more treatment so the bite can be restored. The teeth are essentially the key to putting the puzzle of the facial skeleton back together correctly.

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Dr. Lieblick: When we're called into the hospital for a trauma case, it's often a very stressful and chaotic environment for the patient and their family. A huge part of our initial role is to bring a sense of calm, order, and expertise to that situation.

Dr. Rehrer: While the emergency room team is focused on overall stability—the ABCs of trauma care like airway, breathing, and circulation—our focus is immediately on the facial injuries. Once the patient is stable, we conduct a very thorough and methodical clinical examination.

Dr. Lieblick: This isn't just a quick look. It's a careful, hands-on assessment.

Dr. Rehrer: It is. We are methodically checking for specific signs: any changes in vision or complaints of double vision, which could indicate an eye socket fracture. We test for numbness in the cheeks, lips, or chin, which suggests nerve injury. We gently palpate, or feel, the facial bones for any palpable "steps" or irregularities that indicate a fracture. And, of course, we meticulously check for any discrepancy in how the teeth come together.

Dr. Lieblick: While we are performing that careful clinical assessment, our team is also, when appropriate, talking with the family, explaining what's happening and what the next steps are. Reducing that fear of the unknown is a huge part of our initial role in the ER.

Dr. Rehrer: Following the clinical exam, the definitive diagnosis of facial fractures is made with a high-resolution, fine-cut CT scan. This is absolutely essential. It provides us with that detailed, three-dimensional blueprint of the damage, allowing us to see the precise location, orientation, and severity of every single fracture line. We need that map before we can formulate a precise plan for the repair.

Dr. Lieblick: The types of fractures we treat are quite varied. Mandible, or lower jaw, fractures are very common. For the patient, this immediately means they can't eat, they can't speak properly, and they're in significant pain. Restoring its function is an immediate priority.

Dr. Rehrer: And because the lower jaw is a U-shaped bone, it's susceptible to breaking in more than one place, much like a pretzel might. We frequently see a fracture on one side and another on the opposite side, or a fracture in one area and swelling of the jaw joint. This requires a comprehensive surgical approach to stabilize the entire arch.

Dr. Lieblick: Then you have the midface, which is structurally more complex. Fractures of the cheekbone, or zygoma, are common and can lead to a flattened facial appearance and sometimes problems with jaw movement if not treated correctly.

Dr. Rehrer: The bones of the orbit—the eye socket—are also very delicate. A fracture of the orbital floor, the thin bone beneath the eyeball, can cause the eye to appear sunken or lead to persistent double vision because the small muscles that move the eye can become entrapped in the fracture. These repairs require extreme delicacy and precision.

Dr. Lieblick: We also manage dentoalveolar fractures—injuries specifically to the teeth and the bone that holds them. This can involve teeth being knocked out, or avulsed, or displaced from their normal position. Our immediate goal is to reposition and stabilize them to give them the best possible chance of long-term survival.

Dr. Rehrer: The fundamental principles of treating facial fractures are accurate reduction and stable fixation. Reduction means putting the broken bone fragments back into their correct, pre-injury position.

Dr. Lieblick: And fixation means holding them there securely so the bone can heal properly.

Dr. Rehrer: While wiring the jaws shut was a common method of fixation in the past, the modern standard of care for most significant fractures is a procedure called open reduction and internal fixation.

Dr. Lieblick: This means we make carefully placed incisions, often hidden inside the mouth or in natural skin creases to minimize any visible scarring, so we can directly see and perfectly realign the bone fragments.

Dr. Rehrer: Once the bones are perfectly aligned, we use small, titanium plates and screws to hold them in position. These plates are very strong but low-profile, and they act like small internal casts, providing immediate stability while the bone heals.

Dr. Lieblick: And this is where our dental foundation is so critical. Before we apply any of those plates to the jawbones, we will almost always first put the teeth into their perfect bite. We might use temporary wires or screws, called arch bars, to hold that bite in place. This ensures that we are rebuilding the facial skeleton around the correct functional endpoint.

Dr. Rehrer: That’s exactly right. We build the house from the foundation up, and in maxillofacial surgery, the bite is the foundation. The stability from these modern plating techniques is what allows us to avoid wiring the jaws shut for long periods in most cases, which makes for a much more comfortable recovery and allows for better nutrition and hygiene during healing.

Dr. Lieblick: The recovery from facial trauma surgery is a significant process. A hospital stay is often required, and patients can expect swelling and bruising, which are a normal part of the body's healing response.

Dr. Rehrer: We manage their post-operative discomfort carefully with appropriate medication. A soft, non-chew diet is also necessary for several weeks. This protects the healing fractures from the strong forces of chewing and is critical for a successful outcome. The return to a normal diet is gradual, based on clinical and radiographic signs of bone healing.

Dr. Lieblick: We also focus on the emotional aspect of recovery. A traumatic injury is a major life event that can affect a person's identity and sense of self. Part of our role is to provide compassionate support to the patient and their family as they navigate not just the physical healing, but the emotional healing as well, providing reassurance at follow-up visits as they see themselves returning to normal.

Dr. Rehrer: Following their discharge from the hospital, patients have regular follow-up appointments in our office. We monitor their healing closely with exams and sometimes follow-up imaging to ensure the bones are fusing correctly and their bite remains stable. And as you mentioned, for the most severe trauma cases, we are working as part of a larger multidisciplinary team, collaborating with other specialists like plastic surgeons or neurosurgeons to provide complete care.

Dr. Lieblick: So, to bring it all together, the management of facial trauma is a core component of our specialty, one that relies heavily on our years of hospital-based surgical training. Our unique understanding of the facial skeleton and dental occlusion allows us to restore both form and function for our patients.

Dr. Rehrer: It is a privilege to be able to apply our skills to help people through such a difficult and unexpected time. From the initial emergency room evaluation to the definitive surgical repair using modern plating techniques and the careful management of post-operative recovery, our involvement is comprehensive.

Dr. Lieblick: The ultimate goal is always to guide them from the point of injury back to a state of normalcy and health with the best possible functional and aesthetic outcome, helping to restore their confidence and well-being.

Dr. Rehrer: And while we hope our listeners never need our expertise for this reason, it’s good to understand the level of specialized care that is available should an accident ever occur.

Dr. Lieblick: On that note, the best advice we can offer is a simple reminder about prevention. Please, wear your seatbelt. Wear a helmet when you're on a bike or scooter. Use a mouthguard for contact sports. These simple measures can prevent many of the serious injuries we treat. We hope this discussion has been informative, and we thank you for listening.