Childen's Hospital Boston 300 Longwood Avenue
Boston, MA 02115
(617) 355-6000
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My Child Has:
Facial Fractures
Programs that treat this condition
General Surgery Program  
What are facial fractures?
Facial fractures are broken bones of the face. This kind of a fracture can involve bones of the upper jaw, lower jaw, cheeks, and nose or eye sockets. A closed fracture is one in which the skin is not broken. An open or compound fracture involves laceration of the skin. The majority of facial fractures do not involve children. That is because children's bones are not completely hardened, so their fractures are usually of the "greenstick" variety - an incomplete fracture in which the bone is partially bent and partially broken. Most children's facial fractures heal rapidly with very few complications.

The majority of all facial fractures involve the lower jaw. Although it is the strongest of the facial bones, the lower jaw is also the most vulnerable because of its position. Upper jaw fractures occur about one forth as often as those of the lower jaw do. The nose and the cheekbones, because of their prominence, are also damaged frequently.

If you suspect that your child has a facial fracture, seek medical attention immediately. Facial fractures can result breathing impairment, since the airway can be blocked by bone fragments, swollen tissue, blood clots, dislodged teeth, or pieces of debris.

What causes facial fractures?
Facial fractures during childhood are caused by falls, being struck by a blunt object, and motor vehicle accidents. A small percentage of them are caused by disease.

Fractures of the lower jaw are most often caused by car, bicycle and motorcycle accidents, fistfights, falls and other sports or industrial accidents. They may also result from diseases, such as osteomyelitis (an infection of the bone) metabolic disorders, or tumors. Upper jaw fractures result most commonly from car accidents. Less often, upper jaw fractures result from a blow from a fist.

Fractures of the nasal bones and cheekbones can result from any severe impact to the area. Common causes included blunt objects, falls, fistfights or athletic encounters.

Fractures of the floor of the eye bone socket are called blowout fractures or the orbit. They most often result from a sudden increase in pressure around the eye area due to an external force such as a fist or a baseball. All of the connecting bones in the eye area are compressed, and the system of bone structures gives out (blows out) at its weakest point - the floor of the eye bone socket.

What are the symptoms of facial fractures?
The following are the most common symptoms for facial fractures. However, each child may experience symptoms differently and they vary depending on what kind of facial fracture your child may have experienced. Symptoms can include:
  • pain
  • excessive salivation
  • difficulty swallowing.
  • swelling
  • malocclusion (improper meshing of the upper and lower jaw and teeth)
  • skin discoloration
  • visible jaw deformity
  • nosebleed
  • difficulty breathing
  • lacerations either inside or outside of the nose
  • visible displacement of the nose
  • crackling noise when the ends of a broken bone are rubbed together
If you suspect that your child has a facial fracture, seek medical attention immediately.
How are facial fractures diagnosed?
Diagnosis of facial fractures involves careful observation of the facial structures, followed by X-ray studies. The physician will feel the facial bones - orbital rims, nose, upper and lower jaw, and cheekbones - to discover bone fragments or irregularities of the face. The physician may also look inside the nose and ears for blood clots or discharge of cerebrospinal fluid. (Such a discharge from the ears could mean a base skull fracture.) X-ray films are also needed to diagnose a facial fracture and to rule out other problems such as dislocation or fracture of the neck.
How are facial fractures treated?
Generally, children's broken bones heal rapidly with few complications. Fractures that involve the upper or lower jaw, however, may affect tooth development. For example, teeth about to grow in may come through abnormally or may be deformed.

The usual treatment for facial fractures involves two steps, reduction or "setting of the bone" and fixation. Reduction involves restoring broken pieces to their proper position. In many cases of facial fracture, reduction can be accomplished several days after the injury, once the swelling has subsided.

The second step is fixation; the process of holding the broken pieces together until they have rejoined and the fracture has healed. Most often, this means immobilizing the broken parts.

Many jaw fractures during childhood require only a soft diet. Sometimes jaw fractures require intermaxillary fixation, (IMF): temporary locking of the upper and lower jaws together by wire or rubber bands. The wire or rubber bands are connected to arch bars (metal bars with hooks that are wired to upper and lower teeth). Metal orthodontic bands with brackets ("braces") are also glued onto the teeth. While the jaws are wired shut, only liquid nourishment is possible. The length of time the IMF is in place varies with the extent and severity of the fracture the usual length of time is 3 to 6 weeks.

Nasal fractures fixation is usually accomplished by external splinting and occasionally by packing the inside of the nose with soft material. A blowout fracture may require careful exploration and restoration of the orbital floor.

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