Facial Fractures

What are facial fractures?

Facial fractures are broken bones in 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.
  • Most children’s facial fractures heal rapidly with very few complications.
  • The majority of all facial fractures involve the lower jaw.
  • 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 have a number of causes:

  • falls
  • being struck by a blunt object
  • motor vehicle accidents
  • disease (a very small percentage)

Jaw fractures

Fractures of the jaw are most often caused by:

  • car, bicycle, and motorcycle accidents
  • fistfights
  • falls
  • sports accidents
  • industrial accidents

They may also result from diseases, such as osteomyelitis (an infection of the bone), metabolic disorders, or tumors.

Nasal and cheekbone fractures

Fractures of the nasal bones and cheekbones can result from any severe impact to the area. Common causes include:

  • blunt objects
  • falls
  • fistfights
  • sports accidents

Eye socket fractures

Fractures of the floor of the eye bone socket are called blowout fractures. 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?

Each child may experience symptoms differently and they vary depending on what kind of facial fracture your child may have experienced. Symptoms your child may have 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 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?

Your child’s doctor will first feel the facial bones to discover bone fragments or irregularities of the face.

The doctor may also look inside your child’s nose and ears for blood clots or discharge of cerebrospinal fluid. (Such a discharge from the ears could mean a base skull fracture.)

X-rays 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?

Your child’s physician will discuss specific treatments options with you, but it’s generally pretty straightforward.

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.
  • Fixation is 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.

Jaw fracture fixation

Many children’s jaw fractures only require your child to stick to a soft diet for a period of time. Sometimes jaw fractures require intermaxillary fixation (IMF), which basically means temporary locking of the upper and lower jaws together by wire or rubber bands.

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 three to six weeks.

Nasal fracture fixation

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

What’s my child’s long-term outlook?

Generally, children’s broken bones heal rapidly with few complications.

Don’t panic

The surgeons at the Boston Children’s Hospital General Surgery Program understand how traumatic a facial fracture can be. The good news is that most facial fractures in children heal relatively quickly and without complications. Our experienced staff is here to help heal your child and provide support in this upsetting time.