Facial Trauma

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Introduction

Trauma to the face and head can be caused by a number of events: explosions, gunshot, road traffic accidents, falling masonry, flying glass, etc.

There can be bony damage - fractures can occur in any of the bones of the head and face, but are particularly common in the mandible and nose - and also soft tissue injury. CT scanning is essential for diagnosis as this shows fractures of facial bones more reliably than plain X-ray, and also shows soft tissue injury. Facial and head trauma can also cause damage to the Facial Nerve or the Trigeminal Nerve.

In addition there may be direct damage to the eye.

It is important to be aware that a number of patients who suffer trauma to the upper regions of the face also suffer from brain injury, and some have co-existing cervical spine injury.

Initial repair following serious facial trauma is performed by surgeons; fractured bones will be plated or wired, skin and soft tissue lacerations will be stitched, large areas of severe soft tissue damage may require grafting.

The physiotherapy rehabilitation of these patients is thus largely post operative rehabilitation.

Initial Stages

The face has a very rich blood supply, so healing is usually rapid.

Soft Tissue Injury

In areas of thin skin (eg. the eyelids) sutures can normally be removed after just 3-4 days, and elsewhere on the face they are often removed after 6 days. Sutures in cartilage, for example the ear or the nose, are often left in situ for 10-14 days.

Bony Injury

Surgical repair is often required for bony injury, which may involve wiring or plating, or more substantial surgical techniques to rebuild the damaged bone, such as bone grafting.

Later Stages

Once the surgical repair techniques have been completed, the body continues the healing, producing scar tissue.

The proliferation phase of scar tissue lasts for 2-3 weeks, and it is in this phase that the majority of the scar tissue is laid down.

This is followed by the remodelling phase, when the scar tissue continues to rebuild and remodel.

Please see the Soft Tissue Healing page for more details on scar tissue formation.

Physiotherapy following Facial Trauma

Rehabilitation should begin as soon as the surgeons permit it.

The aim of physiotherapy is to restore as much facial range of movement as possible, which will result in restoration of facial function.

Clinical Presentation

Any of the following may occur, often several in combination:

• Reduced facial range of movement
• Inability to close the eye
• Inability to move the lips eg. into a smile, pucker
• Inability to bite or chew
• Asymmetry of the facial structures
• Difficulties keeping food in the mouth when eating
• Difficulties forming a lip seal on a vessel when drinking
• Dry eye
• Dry mouth
• Reduction in non-verbal communication through facial expression

Rehabilitation

Manual techniques to the soft tissues, and when required to the Temporomandibular Joint, are the main physiotherapeutic modalities utilised.

Temporomandibular Joint Rehabilitation

• Active exercises to increase TMJ range of movement. These should include all TMJ movements:

Nerve Injury Rehabilitation - Facial Nerve

There are a series of pages on this topic; the main one to consult is the Facial Palsy page.