Who treats facial fractures?

Facial Fracture Management: Specialist Care

Facial fractures are primarily treated by three surgical specialties: oral and maxillofacial surgeons (36.6%), plastic surgeons (39.6%), and otolaryngologists/head and neck surgeons (23.3%), with all three specialties demonstrating similar outcomes in patient care. 1, 2

Specialist Distribution and Referral Patterns

Facial trauma management requires specialized surgical expertise, with the distribution of care at level-1 trauma centers showing:

• Plastic Surgery: 39.6% of facial trauma coverage
• Oral and Maxillofacial Surgery: 36.6% of facial trauma coverage
• Otolaryngology/Head and Neck Surgery: 23.3% of facial trauma coverage
• Other services (general surgery, oculoplastics): 0.5% 1

Research shows that outcomes are equivalent regardless of which specialty manages facial fractures. A study from a Level I trauma center demonstrated no significant differences in:

• Overall operative rates
• Complication rates
• Mortality
• Length of hospital stay 2

Initial Assessment and Management

The American College of Radiology recommends:

1. Initial stabilization focusing on airway, breathing, and circulation before facial trauma evaluation
2. CT maxillofacial scan as the first-line diagnostic modality (superior to plain radiographs)
3. Concurrent CT head as 68% of facial fracture patients have associated head injuries 3

Specialized Management by Fracture Type

Different facial fractures require specific management approaches:

LeFort Fractures

• Require CT angiography of supra-aortic and intracranial vessels for LeFort II or III fractures
• Manual reduction of grossly displaced fragments to improve airway patency
• Early definitive repair (within 24 hours) if patient is hemodynamically stable 3

Complex Facial Fractures

• Open reduction and internal fixation (ORIF) with titanium plates and screws
• Treatment within 10 days of injury shows good to excellent outcomes with low complication rates (16.7% reoperation rate) 4

Common Associated Injuries

Be vigilant for concomitant injuries with facial fractures:

• Cerebral hematomas (43.7% of cases) - most commonly subdural hematomas
• Pulmonary injuries (31.1% of cases) - most commonly lung contusions
• High complication rate (50.3%) including pulmonary complications, septicemia, and renal failure 5

Monitoring and Follow-up

• Monitor for clear rhinorrhea suggesting dural tear
• Check for enophthalmos, diplopia, and infraorbital nerve paresthesia
• Follow up with specialists to monitor healing and address complications 3

Important Considerations

• Airway management is critical - 42% of patients with facial fractures require intubation and 14.8% require tracheostomy 5
• Multidisciplinary approach is essential for optimal outcomes in complex cases
• CT imaging has largely replaced radiographs for facial trauma diagnosis 6

The American College of Radiology emphasizes that proper management of facial fractures not only optimizes aesthetic outcomes but also prevents potential morbidity and mortality from delayed treatment 6, 7.