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Dental and Maxillofacial Trauma

Dental trauma refers to injury to the teeth or supporting structures (like gums and jawbone), while maxillofacial trauma refers to injuries affecting the face, jaw, and the surrounding soft tissues.

What is a fracture?

A fracture (a break) can occur in any bone of the skull. The fracture is either simple (two fragments) or complex/comminuted (multiple fragments). The fracture can be closed (no opening in the gingiva or the skin) or open (opening in the gingiva or the skin) where there is an opening in the skin or gingiva over the fracture. Fractures may occur as part of a more complex injury where there has been damage to other tissues such as tendons, nerves and blood vessels.

What are the causes?

Fracture occurs when a force applied to the bone is strong enough to break it. The fracture site and pattern (shape) depends on both the generated and applicated force. The injury circumstances are essential informations that the doctor will need. It is mandatory to be truthful. The treatment could be affected by the injury circumstances. Most of the causes are classified in the following groups: fall, sport, crushing, road accident and violence (fight).

Common Fracture Patterns and Problems

Dental Trauma:

  • Crown Fractures: Breakage or chipping of the visible part of the tooth.
  • Root Fractures: Damage occurring below the gum line.
  • Luxation: Tooth displacement, which includes avulsion (complete dislodgement), extrusion (partial dislodgement), and lateral displacement.
  • Tooth Concussion: Injury to the tooth without visible damage but with sensitivity.

Maxillofacial Trauma:

  • Mandible (Lower Jaw) Fractures: Commonly seen at the angle, body, and symphysis regions.
  • Zygomatic (Cheekbone) Fractures: Often result in a flattened cheek.
  • Nasal Bone Fractures: Cause noticeable swelling and sometimes deformity.
  • Orbital (Eye Socket) Fractures: Might result in double vision or sunken eyes.
  • Maxillary (Upper Jaw) Fractures: Can affect speech, bite, and facial appearance.

Common Associated Problems:

  • Infection: Any open wound or exposed tooth root may become infected if not treated.
  • Nerve Damage: Can lead to numbness or tingling.
  • Malocclusion: Misalignment of teeth due to jaw fractures.
  • Aesthetic Concerns: Changes in facial appearance.
  • Long-Term Complications: Such as tooth loss or difficulty opening the mouth.

What are the signs and symptoms

Depending on the site of fracture on the maxillofacial region, you will suffer from different symptoms such as pain, swelling, bruising and loss of movement. There may be numbness or pins and needles. There may be an obvious deformity on the face. In an open fracture, there will be a wound.

What should you do?

If you suspect you or someone to have a facial, you should attend or refer for further medical care either at a hospital emergency department, or in a department of maxillofacial surgery, or in a maxillofacial surgery private practice.


Immediate Care:

  • Keep the injured area clean.
  • For avulsed teeth, store them in milk or clear water and seek immediate dental attention.
  • Apply cold compresses to manage swelling.

Professional Assessment:

  • Visit a dentist or maxillofacial surgeon immediately for proper assessment.
  • X-rays or CT scans might be required to determine the extent of the injury.

Treatment Options:

For Dental Trauma:

  • Restorative Procedures: Fillings or crowns for chipped or fractured teeth.
  • Root Canal Therapy: For deep fractures that expose the tooth pulp.
  • Tooth Repositioning: For luxated teeth.
  • Tooth Reimplantation: For avulsed teeth, ideally within 1 hour of the injury.
  • Tooth Extraction: If the tooth cannot be saved.
  • Closed Reduction: Non-surgical method where the bones are set back in place without cutting open the skin.
  • Open Reduction and Internal Fixation (ORIF): Surgical procedure where the bones are set in place using plates, screws, or wires.
  • Supportive Therapies: Such as pain management, antibiotics, or physical therapy.

For Maxillofacial Trauma:

  • Closed Reduction: Non-surgical method where the bones are set back in place without cutting open the skin.
  • Open Reduction and Internal Fixation (ORIF): Surgical procedure where the bones are set in place using plates, screws, or wires.
  • Supportive Therapies: Such as pain management, antibiotics, or physical therapy.

What can I expect after an operation?

  • Pain and swelling : The patient will have some pain and swelling. The first days after the surgical procedure are usually the worst. However, the pain will disappear completely within weeks. You will get prescriptions of painkillers and NSAID to take regularly after the surgery.
  • Infection : There is a risk of infection. The patient will receive intravenous antibiotics during the surgical procedure and the hospitalisation. You will also get a prescription for antibiotics to take when you go home in prevention. 
  • Hygiene:  It is mandatory to have a good oral hygiene for the first few weeks after surgery in order to prevent infection. Brushing teeth  around stitches is sometime difficult because of soreness. To help a You can clean the area after eating by gently rinsing your mouth with a mouthwash or with warm salty water (dissolve a teaspoon of kitchen salt in a cup of warm water), starting on the day after surgery.
  • Soft food: Although the plates and screws hold your jaw in place it still takes about six weeks for your jaw to heal completely. During this time, you need to eat soft food only. Your surgeon will give you advice on this. You must be careful to avoid another injury as it may push your jaw out of position again. Any wires on your teeth will be removed when your surgeon is happy that your fracture has healed. The plates and screws are not usually removed.

Intermaxillary fixation (IMF)

What is Intermaxillary Fixation?

Intermaxillary Fixation (IMF) is a procedure used in the field of oral and maxillofacial surgery to stabilize the upper (maxillary) and lower (mandibular) jaws in a specific alignment. This is often done to facilitate healing after trauma.

Different Methods of Intermaxillary Fixation:


  • Eyelet Wiring: Wires are threaded through small holes drilled into teeth, and these wires are then used to fix the maxilla and mandible together.
  • Circummandibular and Circumzygomatic Wiring: Wires are looped around the lower jaw and around the zygomatic arch, respectively, and then used for fixation.
  • Arch Bar or Ivy Loop Wiring: Metal bars or loops are attached directly to the teeth using wires. The upper and lower bars are then wired together to immobilize the jaws.

Interosseous Wiring: Direct wiring of fractured bone fragments.

Bone Plates and Screws: These are applied directly to the fractured bone segments, holding them together without necessarily immobilizing the jaws. This is often used in conjunction with IMF, which is removed once adequate healing has taken place.

Elastic Bands: Sometimes, after initial stabilization with wires or plates, elastic bands are used to guide the bite and jaw movements. These bands can be easily put on and taken off, allowing some jaw movements.

Hybrid Techniques: Combination of traditional wiring techniques with more modern methods, like mini-plates or screws.


What This Means for you:

Eating and Nutrition:

  • You will be on a liquid or soft diet. You will need to avoid solid foods to prevent disruption to the fixation.
  • Nutritional shakes and smoothies can help ensure you receive necessary nutrients. More advise below.

Speech and Communication:

  • IMF can make speaking clearly more challenging. You might find it hard to articulate certain words, but with time, many adapt to this temporary change.

Oral Hygiene:

  • Maintaining oral hygiene is crucial but more challenging. You are advised to use mouthwashes frequently and may be prescribed specific rinses to keep the mouth clean.
  • A soft toothbrush can be used carefully around the wires or bands.

Discomfort and Pain:

  • Some discomfort or pain is expected, especially in the initial days. Pain medication will be prescribed if needed.


  • The duration of IMF varies based on the reason for the procedure. It can range from a few weeks to several months.

Emergency Precautions:

  • Since the jaws are immobilized, vomiting can be a serious concern. You are usually provided with wire cutters or instructions on how to release the fixation in an emergency.

Follow-up Visits:

  • Regular visits to the surgeon are essential to monitor healing and make any necessary adjustments.

Emotional Impact:

  • Having the jaws immobilized can be an emotionally challenging experience. Support from friends, family, and professionals can be invaluable during this time.

Always remember that IMF, while restrictive, is a temporary measure. Its purpose is to ensure the best possible outcome in healing and alignment of your jaws and teeth.

What are the risks?

As with all surgery there is a risk of pain, swelling, bruising, bleeding and infection.

Slight bleeding from the cuts inside your mouth is common in the first day or so after

surgery. It is unlikely to be a problem and it can usually be stopped by putting pressure on

the area for at least 15 minutes with a rolled up damp handkerchief or gauze swab.

Infection in the gum or bone. Taking your antibiotics will usually prevent this.

Damage to nearby teeth.

Nerve damage – there is a nerve that runs through a tunnel in the centre of your lower jaw.

This nerve gives the feeling to your lower lip, chin and bottom teeth. If it was bruised or torn when your jaw was broken you might already feel some tingling or numbness in your lip or chin. This tingling may also be caused or made worse by surgery. For most people who have tingling or numbness, it does get better on its own – although this can take several months. Some people have permanent numbness afterwards.

Infected plates or screws – if this happens, they need to be removed. This can happen soon after your surgery or it may happen many years later. The metal that is used is titanium, which does not set off metal detectors.

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