From the Research
For a military member with a communited nasal bone fracture, maxillary spine fracture, and anterior maxillary wall fracture, I recommend a temporary profile restriction of no contact sports or activities with risk of facial trauma for 6-8 weeks, no wearing of tight-fitting masks or helmets for 4 weeks, and no deployment to austere environments without access to ENT care for 3 months. The member should be placed on light duty with no physical training or combat training for the first 2-3 weeks, then gradually return to modified duties avoiding activities that could cause facial impact. Nasal breathing exercises should begin after initial healing (around 2 weeks) to maintain airway patency. Pain management typically includes acetaminophen 650mg every 6 hours and ibuprofen 600mg every 8 hours for 7-10 days, with ice packs applied 20 minutes on/off for the first 48-72 hours to reduce swelling, as suggested by 1. These restrictions are necessary because premature return to full duty risks displacement of healing bone fragments, which could lead to permanent nasal deformity, breathing difficulties, or chronic sinusitis. The maxillary fractures particularly require protection as they support facial structure and sinus integrity. Follow-up with an ENT specialist at 2 weeks, 6 weeks, and 3 months is essential to ensure proper healing before returning to full duty status. Key considerations in managing musculoskeletal injuries, such as those discussed in 2 and 3, emphasize the importance of identifying and mitigating risk factors to prevent further injury and ensure successful rehabilitation. However, the specific management of facial fractures, particularly in the context of military service, prioritizes protection of the fracture sites and gradual return to duty to minimize complications and ensure optimal recovery, as informed by general principles of fracture management and rehabilitation. The decision to return to duty should consider both the individual's health condition and the potential risks associated with military duties, as discussed in 4. Ultimately, the goal is to balance the need for military readiness with the necessity of ensuring the service member's safety and promoting optimal recovery from their injuries.