Facial Fractures (other than nasal fractures)

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What are midface fractures?

Midface fractures involve the bones from the forehead to the lower jaw (mandible). They are rare in pediatric patients. The different types of fractures include LeFort fractures, Naso-orbital-ethmoid fractures, and zygoma fractures.

What to expect for work-up of facial fractures?

Your child may be admitted to the hospital for initial trauma injuries or for post-operative observation. Depending on the type of fracture or cause of injury, your child’s evaluation may include a CT scan, a full trauma evaluation, and a dental exam.

How are midface fractures treated?

Your child’s fractures may be treated with observation or surgery depending on extent of injury. If surgery isn’t necessary, your child may be put on a soft diet for a few weeks with no contact sports. If surgery is needed, your child may have incisions under the lip (sublabial), by the eyebrow, in the lower eyelid, or across the hairline (bicoronal).  Small plates or screws may be used to keep the small bone fragments in alignment.

What to expect after surgery for midface fractures?

If incisions are made inside the mouth, your doctor may prescribe a mouthwash and a soft or liquid diet.

If your child has an incision on the lower eyelid, your doctor may prescribe eye drops or ointment and additional vision checks.

If your child has an incision across the hairline, a surgical drain may be left in place for a few days. The eyes can often become quite swollen after surgery.

Your child doctor may prescribe antibiotics depending on the type and extent of injury.

What about jaw fractures?

Mandible fractures are the most common facial fracture that result in hospital admission. Although mandible fractures are uncommon in young children, they become more common in teenagers and young adults. The most common causes are motor vehicle and bike accidents, sports injuries, and falls.

How are mandible fractures evaluated?

Your child may have a panorex x-ray or a CT scan to look for fractures of the jaw. A physical exam will include assessment of any loose or chipped teeth. The bite of the upper and lower jaw will be checked to make sure that your child’s teeth line up.

How are mandible fractures treated?

Many mandible fractures require surgery. Although an ENT surgeon may be involved in the evaluation and management of your child’s jaw fracture, most pediatric mandible fractures are be managed by an oral surgeon. Incisions are usually made inside the mouth along lower gumline, but occasionally a cheek or neck incision is necessary. The broken bones are often held in place with small surgical plates.

Although it isn’t common nowadays, your child may need to have the teeth wired together after surgery. If so, your child will need a liquid diet for a few weeks.

Are there any instructions I need to follow before surgery?

Your child must have a physical examination by his or her pediatrician or family doctor within a few days before surgery to make sure they are in good health. Often your child will have had an exam with the Emergency Department or Trauma team based on the facial trauma. The doctor you see needs to complete the History and Physical form provided by our office. You must bring the completed form with you the day of surgery.

For your child's safety, it is very important that they have an empty stomach when anesthesia is given. Please follow Children’s Hospitals’ Eating and Drinking Guidelines. If you do not follow these guidelines, your child's surgery will be cancelled. Your child may be on a soft diet after the injury even before surgery.

What can I expect after surgery?

The procedures generally take 2-3 hours. Your child will wake up in the recovery room after surgery. This usually takes no more than 20 to 40 minutes. When your child is awake, he or she will be taken to the discharge area to complete the recovery. You can be with your child once he or she is back in the recovery area. Your child may have to stay in the hospital overnight after surgery depending on any other trauma injuries sustained with the facial fractures.

• Your child may have a facial dressing (sometimes called a jaw bra) which helps support the jaw. It has pockets to place ice to help with swelling
• Your doctor may prescribe an antibiotic mouthwash
• Your doctor may prescribed antibiotics for infection, bad teeth, or cuts in the mouth
• Your child will need to avoid contact sports for about 4 weeks

• Fevers up to 102.0 F are considered normal after surgery. Call your provider for fevers over 102.0 F that do not come down with acetaminophen (Tylenol) and/or Ibuprofen
• Your child may have jaw pain, facial pain, eye pain or tooth pain. Occasionally he/she may complain of double vision. You can treat this short-term discomfort with Tylenol^® (acetaminophen) or Children's Motrin^® (ibuprofen).  Occasionally stronger pain medications are prescribed.
• Swelling around the eye is very common. It is usually worse in the morning and generally improves over the next week.
• You will get a Discharge Instructions sheet before you go home which will indicate how much medicine to give and how often.
• Your child may be on a liquid or soft diet for a few weeks after surgery.
• Wound care may include mouth wash, eye drops, or antibiotic ointment.

Questions?

The information provided in this brochure is not specific to your child. This information is provided as a service to our patients. The information is for educational and informational purposes only and should NOT be used as a substitute for the advice of your child’s physician. If you have any questions, please call Children’s ENT and Facial Plastic Surgery Clinic.

Reviewed 10/2022

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