Facial fractures Emergency Department leaflet

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Overview

You have been assessed by staff in the Emergency Department and found to have broken a bone in your face, i.e. sustained a facial fracture. You have been assessed for other injuries before being discharged from the department.

If you have a fracture of the cheek bone, you should not blow your nose for about ten days following the injury. This is because you might force air from your sinuses into the skin, which can result in facial swelling around the eyes. This swelling is temporary and will disappear with time.

If you have had a facial fracture, you should avoid knocks or bumps to the area for at least 6-8 weeks until the fracture has healed. This is because ‘impacts’ on fractured areas might move the affected bones.

We may prescribe a course of antibiotics for you depending on your injury.

Seek immediate medical attention if you have worsening pain, signs of infection such as fever, or redness around your wound, or if you have any other concerns such as vision changes, vomiting, unusual drowsiness or problems with breathing, or swallowing.

Information about facial fractures

You have been assessed by a clinician in the emergency department and asked about the events that caused your injury, your general health and your current symptoms, and assessed for injuries. Unfortunately, you have been found to have a facial fracture.

Please let us know if you are in pain and we can provide you with pain relief.

What are facial fractures?

Facial fractures are fractures (broken bones) of the face and mouth. They commonly include fractures of the nose (nasal), cheekbones (zygoma), as well as to bones surrounding the eyes (orbit) and upper (maxilla) and lower (mandible) jaws.

If you have a facial fracture, we will usually refer you to the oral and maxillofacial services team or the ear, nose and throat (ENT) team.

What causes facial fractures?

Most facial fractures are acute (sudden) and caused by assaults (for example, fighting), sports (for example, horse riding, football and rugby) and accidents (for example, road traffic or falls).

How will I know if I have a facial fracture? 

If you have had some kind of blunt or sharp trauma to your face, your clinician will assess you for facial and other fractures. They will examine you carefully (looking for changes in mobility, swelling and pain) but will also send you for X-rays. Most fractures show up clearly (as dark lines) on head, facial, jaw and dental X-rays. Some small (hairline) fractures are more difficult to see and require further X-rays and follow-up appointments.

What are treatments options?

The treatment options that you will be offered will depend on the type and extent of the fracture and any other problems you might have at the time.

The vast majority of facial fractures have a normal alignment and require no acute treatment. They will heal themselves over 3 to 6 weeks.

If the fracture is not in alignment, we will want to bring the broken bones back into a normal alignment (called ‘reducing’ the fracture) and keep it/them in this place (called ‘fixing the fracture’), preventing further injury. Sometimes they will need to operate to do this. Sometimes they will need to use plates, screws or wires (or other fixation) inside or occasionally outside the bones to hold the fractures in place. A specialist surgeon will explain more about your fracture(s) and its treatment.

My face is numb or feels odd after a facial injury: how long will this last?

The facial bones have many channels in them in which small nerves run. These nerves are sensory nerves (sensing hot, cold, touch, pain etc) or motor nerves (controlling facial movement). When the nerves emerge from the bones they distribute themselves through the soft tissues and skin of the face.

When you have had a facial injury (including a fracture) your soft tissues, skin and the bones are likely to be bruised, swollen and damaged. This can lead to short-term pain but also numbness or altered sensation to the face. Depending on the position and extent of injury, this change in sensation often takes a number of weeks or maybe even months to disappear completely. Very occasionally, only partial or no recovery occurs. Motor nerves tell muscles how and when to move. They run between the facial bones and the skin and can be injured by trauma.

How long will the fracture take to heal?

This will depend on the type and extent of fracture and what other problems and treatment you had. Bruising and swelling usually takes 2 to 3 weeks to settle down. At this point, you will begin to look more normal. After this time the body will continue to heal itself inside.

If you have any concerns, please seek medical advice.

General support

For general medical advice please use the NHS website, the NHS 111 service, walk-in-centres, or your GP.

• The NHS website provides online health information and guidance.
• NHS 111 phone line offers medical help and advice from trained advisers supported by nurses and paramedics. Available 24 hours a day. Calls are free from landlines and mobile phones
• There are walk-in and urgent treatment services at Brighton Station, in Crawley and at Lewes Victoria Hospital
• Patient Advice and Liaison Service (PALS) can be contacted with your comments and concerns, and to provide general support