At one time or another, everyone has had a minor facial injury that caused pain, swelling, or bruising. Home treatment is usually all that is needed for mild bumps or bruises.

Facial injuries most commonly occur during:

·         Sports or recreational activities, such as ice hockey, basketball, rugby, soccer, or martial arts.

a·         Motor vehicle crashes.

·         Falls.

·         Fights.

In children, most facial injuries occur during sports or play or are caused by falls. Minor facial injuries in young children tend to be less severe than similar facial injuries that occur in older children or adults. Young children are less likely to break a facial bone because they have fat pads that cushion their faces and their bones are more flexible. But young children are more likely to be bitten in the face by an animal.

Head injuries may occur at the same time as a facial injury, so be sure to check for symptoms of a head injury. For more information, see the topicHead Injuries, Age 3 and Younger or Head Injuries, Age 4 and Older.

Facial injuries may be caused by a direct blow, penetrating injury, or fall. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

·         A cut or puncture to your face or inside your mouth. This often occurs with even a minor injury. But a cut or puncture is likely to occur when a jaw or facial bone is broken. The bone may come through the skin or poke into the mouth.

·         Bruises  from a tear or rupture of small blood vessels under the skin.

·         Broken bones, such as a fractured cheekbone 

·         A dislocated jaw, which may occur when the lower jawbone (mandible) is pulled apart from one or both of the joints connecting it to the base of the skull at the temporomandibular (TM) joints. This can cause problems even if the jaw pops back into place.

Treatment for a facial injury may include first aid measures, medicine, and in some cases surgery. Treatment depends on:

·         The location, type, and severity of the injury.

·         How long ago the injury occurred.

·         Your age, health condition, and other activities, such as work, sports, or hobbies.

When you have had a facial injury, it is important to look for signs of other injuries, such as a spinal injury, eye injury, or an injury to themouth, such as a cut lip or injured tooth.

Check Your Symptoms

Call 911 anytime you think you may need emergency care. For example, call if:

·         You have a seizure.

·         You passed out (lost consciousness).

·         You have tingling, weakness, or numbness on one side of your body.

Call your doctor now or seek immediate medical care if:

·         You have a severe headache.

·         You develop double vision.

·         You have a fever and stiff neck.

·         Clear, watery fluid drains from your nose.

·         You feel dizzy or lightheaded.

·         You have new eye pain or changes in your vision, such as blurring.

·         You have new ear pain, ringing in your ears, or trouble hearing.

·         You are confused, irritable, or not acting normally.

·         You have a hard time standing, walking, or talking.

·         You have new mouth or tooth pain, or you have trouble chewing.

·         You have increasing pain even after you have taken your pain medicine.

Watch closely for changes in your health, and be sure to contact your doctor if:

·         You develop a cough, cold, or sinus infection.

·         The symptoms from your injury are not steadily improving.

Facial Injuries

The face is the most vulnerable area of the body and is usually the least protected. Sports-related facial injuries account for 8% of all facial soft tissue injuries. Approximately 11-40% of all sports injuries involve the face. These injuries are most often due to direct hits with a ball or player-to-player contacts. Health-care providers for athletes should be familiar with the anatomy of the facial region, the most common types of facial injuries, and the initial management of facial injuries.

The most common types of sports-related facial trauma are the soft tissue injuries and the fractures of the "T-Zone" bones (the nose, the zygoma, and the mandible). These injuries often occur in combination. Depending on the extent and the types of injury, some injuries can be managed at the sporting event site, with the athlete resuming play immediately. Other injuries may demand transfer to an urgent care setting and management by a specialist.

Facial injuries include injuries involving the mouth, face and jaw. These range from facial cuts and lacerations to more serious problems, such as broken teeth and facial bones.

Bone fractures can involve the lower or upper jaw, palate, cheekbones and eye sockets. These injuries often occur during automobile accidents, sports or recreational activities, fights or assaults, work-related tasks, projects around the house or accidental falls.

Many patients with facial injuries are first seen in the emergency room and then referred to an oral and maxillofacial surgeon or a plastic surgeon for further treatment.

Symptoms may include:

·         Difficulty breathing, seeing, talking or swallowing

·         Facial swelling or misshapen face

·         Cut or puncture wound on your face

·         Facial pain

·         Bruising or discoloration behind your ears, eyes or under your tongue

·         Widening of the distance between your eyes, which may indicate injury to your eye sockets

·         Facial numbness or tingling

·         Skin infections or rashes

·         When making a diagnosis, your doctor will begin by asking about your medical history, including any events that may have caused your facial injury. A thorough physical and medical examination will also be conducted, to note any injuries to your face and other parts of your body. Many people with facial injuries also suffer from additional medical problems.

 

Causes of facial injuries

Facial injuries most commonly occur during:

·         Sports or recreational activities, such as ice hockey, basketball, rugby, soccer, or martial arts.

·         Work-related tasks or projects around the home.

·         Motor vehicle crashes.

·         Falls.

·         Fights.

In children, most facial injuries occur during sports or play or are caused by falls. Minor facial injuries in young children tend to be less severe than similar facial injuries that occur in older children or adults. Young children are less likely to break a facial bone because they have fat pads that cushion their faces and their bones are more flexible. But young children are more likely to be bitten in the face by an animal.

Head injuries may occur at the same time as a facial injury, so be sure to check for symptoms of a head injury. For more information, see the topic Head Injuries, Age 3 and Younger orHead Injuries, Age 4 and Older.

Types of injuries

Facial injuries may be caused by a direct blow, penetrating injury, or fall. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

·           A cut or puncture to your face or inside your mouth. This often occurs with even a minor injury. But a cut or puncture is likely to occur when a jaw or facial bone is broken. The bone may come through the skin or poke into the mouth.

·           Bruises from a tear or rupture of small blood vessels under the skin.

• Broken bones, such as a fractured cheekbone .
• A dislocated jaw, which may occur when the lower jawbone (mandible) is pulled apart from one or both of the joints connecting it to the base of the skull at the temporomandibular (TM) joints. This can cause problems even if the jaw pops back into place.

 Facial trauma, also called maxillofacial trauma, is any physical trauma to the face. Facial trauma can involve soft tissue injuries such as burns, lacerationsand bruises, or fractures of the facial bones such as nasal fractures and fractures of the jaw, as well as trauma such as eye injuries. Symptoms are specific to the type of injury; for example, fractures may involve pain, swelling, loss of function, or changes in the shape of facial structures.

Facial injuries have the potential to cause disfigurement and loss of function; for example, blindness or difficulty moving the jaw can result. Although it is seldom life-threatening, facial trauma can also be deadly, because it can cause severe bleeding or interference with the airway; thus a primary concern in treatment is ensuring that the airway is open and not threatened so that the patient can breathe. Depending on the type of facial injury, treatment may include bandaging and suturing of open wounds, administration of ice, antibiotics and pain killers, moving bones back into place, and surgery. When fractures are suspected, radiography is used for diagnosis. Treatment may also be necessary for other injuries such as traumatic brain injury, which commonly accompany severe facial trauma.

In developed countries, the leading cause of facial trauma used to be motor vehicle accidents, but this mechanism has been replaced by interpersonal violence; however auto accidents still predominate as the cause in developing countries and are still a major cause elsewhere. Thus prevention efforts include awareness campaigns to educate the public about safety measures such as seat belts and motorcycle helmets, and laws to prevent drunk and unsafe driving. Other causes of facial trauma include falls, industrial accidents, and sports injuries.

Injury mechanisms such as falls, assaults, sports injuries, and vehicle crashes are common causes of facial trauma in children as well as adults. Blunt assaults, blows from fists or objects, are a common cause of facial injury.Facial trauma can also result from wartime injuries such as gunshots and blasts. Animal attacks and work-related injuries such as industrial accidents are other causes. Vehicular trauma is one of the leading causes of facial injuries. Trauma commonly occurs when the face strikes a part of the vehicle's interior, such as the steering wheel.In addition, airbags can cause corneal abrasions andlacerations (cuts) to the face when they deploy.

Fractures of facial bones, like other fractures, may be associated with pain, bruising, and swelling of the surrounding tissues (such symptoms can occur in the absence of fractures as well). Fractures of the nose, base of the skull, or maxilla may be associated with profuse nosebleeds. Nasal fractures may be associated with deformity of the nose, as well as swelling and bruising. Deformity in the face, for example a sunken cheekbone or teeth which do not align properly, suggests the presence of fractures. Asymmetry can suggest facial fractures or damage to nerves.People with mandibular fractures often have pain and difficulty opening their mouths and may have numbness in the lip and chin With Le Fort fractures, the midface may move relative to the rest of the face or skull.

Radiography, imaging of tissues using X-rays, is used to rule out facial fractures. Angiography (X-rays taken of the inside of blood vessels) can be used to locate the source of bleeding. However the complex bones and tissues of the face can make it difficult to interpret plain radiographs; CT scanning is better for detecting fractures and examining soft tissues, and is often needed to determine whether surgery is necessary, but it is more expensive and difficult to obtain. CT scanning is usually considered to be more definitive and better at detecting facial injuries than X-ray. CT scanning is especially likely to be used in people with multiple injuries who need CT scans to assess for other injuries anyway.

Injury mechanisms such as falls, assaults, sports injuries, and vehicle crashes are common causes of facial trauma in children as well as adults. Blunt assaults, blows from fists or objects, are a common cause of facial injury. Facial trauma can also result from wartime injuries such as gunshots and blasts. Animal attacks and work-related injuries such as industrial accidents are other causes. Vehicular trauma is one of the leading causes of facial injuries. Trauma commonly occurs when the face strikes a part of the vehicle's interior, such as the steering wheel.In addition, airbags can cause corneal abrasions andlacerations (cuts) to the face when they deploy.

Fractures of facial bones, like other fractures, may be associated with pain, bruising, and swelling of the surrounding tissues (such symptoms can occur in the absence of fractures as well). Fractures of the nose, base of the skull, or maxilla may be associated with profuse nosebleeds. Nasal fractures may be associated with deformity of the nose, as well as swelling and bruising. Deformity in the face, for example a sunken cheekbone or teeth which do not align properly, suggests the presence of fractures. Asymmetry can suggest facial fractures or damage to nerves. People with mandibular fractures often have pain and difficulty opening their mouths and may have numbness in the lip and chin. With Le Fort fractures, the midface may move relative to the rest of the face or skull.

Radiography, imaging of tissues using X-rays, is used to rule out facial fractures.Angiography (X-rays taken of the inside of blood vessels) can be used to locate the source of bleeding.^[16] However the complex bones and tissues of the face can make it difficult to interpret plain radiographs; CT scanning is better for detecting fractures and examining soft tissues, and is often needed to determine whether surgery is necessary, but it is more expensive and difficult to obtain. CT scanning is usually considered to be more definitive and better at detecting facial injuries than X-ray.CT scanning is especially likely to be used in people with multiple injuries who need CT scans to assess for other injuries anyway.