What type of specialist treats face bone disorders?

Facial Bone Disorders: Specialist Referral

Facial bone disorders are primarily managed by oral and maxillofacial surgeons, who are the definitive specialists for surgical treatment of conditions affecting the facial skeleton, including trauma, congenital malformations, and reconstructive needs. 1

Primary Specialists for Facial Bone Disorders

Oral and Maxillofacial Surgeons

• Oral and maxillofacial surgeons are the primary specialists for comprehensive management of facial bone pathology, including fractures, deformities, and reconstructive procedures 1, 2
• These specialists complete dental school followed by 4-6 years of surgical residency training, with board certification by the American Board of Oral and Maxillofacial Surgery 3, 4
• Their scope encompasses the entire facial skeleton: mandible, maxilla, zygoma, orbital bones, nasal bones, and frontal bone 1, 5
• For conditions like osteonecrosis of the jaw, primary care clinicians should refer directly to an oral surgeon or maxillofacial surgeon 1

Pediatric Plastic Surgeons (For Pediatric Populations)

• Infants, children, and adolescents with congenital malformations of facial bone structures (skull, jaws, facial asymmetries) should be referred to a pediatric plastic surgeon 1
• This includes conditions such as craniosynostosis, hemifacial microsomia, cleft lip and palate, and malocclusion requiring surgical correction 1
• Pediatric plastic surgeons complete 6+ years of surgical training plus an additional year in pediatric plastic/craniofacial surgery 1

Specific Clinical Scenarios and Appropriate Referrals

Facial Trauma

• Patients with facial bone fractures following trauma require referral to oral and maxillofacial surgeons or head and neck surgeons for definitive management 1
• Frontal bone fractures, representing 5-15% of facial fractures, often involve high-energy trauma and may require neurosurgical consultation for associated intracranial injuries 1
• Midface fractures (zygoma, maxilla, orbital floor) and mandibular fractures are managed primarily by oral and maxillofacial surgeons 1, 5

Jaw Pain with Palpable Mass

• Unilateral jaw pain with a palpable neck or jaw mass requires urgent referral (within 1-2 weeks maximum) to an oral and maxillofacial surgeon or ENT specialist due to concern for malignancy, salivary pathology, or serious infection 2
• Head and neck malignancy must be considered, particularly in patients over 40 with risk factors (tobacco, alcohol use) 2

Osteonecrosis of the Jaw

• Primary care clinicians should monitor for jaw swelling, pain, or exposed mandibular bone and refer to an oral surgeon, maxillofacial surgeon, oral oncologist, or dentist when osteonecrosis is suspected 1
• Depending on locale, head and neck surgeons or otolaryngologists may also have expertise in managing this condition 1
• Conservative management with broad-spectrum antibiotics and chlorhexidine irrigations should be initiated for early lesions before surgical referral 1, 2

Temporomandibular Joint Disorders

• Complex TMJ disorders, including internal derangement, ankylosis, and condylar abnormalities, require referral to oral and maxillofacial surgeons 1
• Advanced imaging (CBCT or MRI) is typically coordinated by the specialist 1

Common Pitfalls to Avoid

• Do not delay referral for suspected malignancy: Any unilateral jaw mass, non-healing ulceration, or induration in adults over 40 requires prompt specialist evaluation 2
• Avoid aggressive debridement in osteonecrosis: Conservative management should be attempted first, with surgical intervention reserved for failed conservative measures 1, 2
• Do not assume all facial bone issues require plastic surgery: Oral and maxillofacial surgeons are the primary specialists for most facial skeletal pathology, with plastic surgeons primarily involved in pediatric craniofacial cases and soft tissue reconstruction 1, 3
• Recognize that facial bone trauma often involves multiple systems: High-energy frontal bone fractures have 33% incidence of intracranial injury and may require coordinated care with neurosurgery 1

Multidisciplinary Coordination

• Coordinated care between primary care, the specialist, and the patient's dentist is essential for optimal outcomes 2
• For pediatric cases, oral and maxillofacial surgeons often work as part of multispecialty teams including pediatricians and other pediatric surgical specialists 1
• Facial reconstruction following trauma or tumor resection may involve both oral and maxillofacial surgeons and plastic surgeons working collaboratively 1, 3