Facial Injuries After a Car Accident

Facial Injury Basics After a Crash

Facial trauma is an injury of the face, and it may include the facial bones such as the upper jaw, according to MedlinePlus. The same entry lists car and motorcycle crashes among the common causes and says these injuries can affect the upper jaw, lower jaw, cheek, nose, eye socket, or forehead, either from blunt force or from a wound.

A 2009 study in the Annals of Advances in Automotive Medicine drew on a national sample of U.S. crashes from 1993 to 2007 to examine the pattern of facial fractures in crashes. The study found that contusions and lacerations each made up 32% of facial injuries, abrasions 21%, and fractures 11%. Its authors concluded that facial fractures are rare overall and are associated with more severe impacts and lack of restraints.

Facial bones are thinner than many other bones in the body, which Cleveland Clinic says makes them prone to injury.

Airbags, Glass, and the Steering Wheel

The direction of impact changes which bones break, according to the 2009 crash study, which found a facial fracture 1.5 times more likely in a frontal impact than in a side impact. The nose was by far the most common bone fractured in frontal impacts regardless of restraint use, while the frontal bone of the forehead and the mandible were fractured most often in side impacts, the authors report.

The study also traced fractures to parts of the car. The A-pillar, the post that frames the windshield, was among the most common injury sources for belted occupants exposed to an airbag in frontal impacts, and the authors found windshield contact was more common for right front passengers in frontal impacts than for drivers.

Seat belts reduced the risk of a facial fracture by 74% in frontal impacts, according to the same study, and airbag deployment also decreased the risk of facial injury or fracture, with a greater effect for belted occupants.

Cuts, Scrapes, and Deep Lacerations

A laceration is a rip or tear in the body’s tissues, and Cleveland Clinic lists vehicle crashes among its common causes. Cleveland Clinic says lacerations usually involve sharp edges, blunt force, or shearing, and many involve more than one of these, especially when the laceration is more severe.

The face and scalp typically bleed very heavily because they are packed full of capillaries, Cleveland Clinic explains, and its checklist for minor lacerations notes that a wound affecting the face is more likely to need professional care.

A deep cut can affect tendons, muscles, ligaments, nerves, blood vessels, or bone, according to MedlinePlus. The encyclopedia advises contacting a health care provider right away when a wound is more than a quarter inch (0.64 centimeter) deep, on the face, or reaching the bone, and says stitches may be needed.

Symptoms That Call for Prompt Care

MedlinePlus lists the symptoms of facial trauma as changes in feeling of the face, a deformed or uneven face or facial bones, difficulty breathing through the nose due to swelling and bleeding, double vision, missing teeth, and swelling or bruising around the eyes that may cause vision problems.

Abnormal feelings on the cheek, irregularities of the face that can be felt by touching, and movement of the upper jaw when the head is still may suggest bone fractures, the same MedlinePlus entry says. Bruising around the eyes or a widening of the distance between them may mean injury to the bones between the eye sockets.

The signs below come from MedlinePlus pages on cuts and puncture wounds, eye emergencies, and broken or knocked-out teeth, and from Cleveland Clinic, which list them as reasons for emergency care or a visit right away.

Broken Bones in the Nose, Cheek, and Jaw

The most common facial fractures, according to Cleveland Clinic, include breaks of the nose, forehead, eye sockets, cheekbones, and upper or lower jaw, along with the midface breaks known as Le Fort fractures. Among drivers and right front passengers in frontal impacts, the 2009 crash study found the most common facial fractures were to the nose, mandible, orbit, and maxilla.

A broken nose can cause a bloody nose, bruises around the eyes and nose, a crooked nose, and trouble breathing through the nose, Cleveland Clinic says. The injury can also cause a septal hematoma, a pool of blood in the septum, which Cleveland Clinic warns can lead to a hole in the septum or saddle nose, where the bridge of the nose collapses.

Fractured jaw symptoms may include drooling, difficulty chewing or speaking, pain when opening the mouth, and loose, broken, or missing teeth, according to Cleveland Clinic. The page on car accident facial fractures covers each fracture pattern in more detail, and jaw joint pain is covered on the TMJ and jaw injury page.

Eye and Orbit Damage From Airbags

MedlinePlus names airbags, along with fists and tennis balls, as common causes of blunt trauma to the eye. Blunt trauma to the face often leaves a black eye, and MedlinePlus says the bruise gradually turns purple, green, and yellow over several days as the blood is absorbed, with the color gone within 2 weeks. Blunt trauma can also cause a hyphema, which MedlinePlus describes as blood inside the front of the eye.

A 1999 review in the Transactions of the American Ophthalmological Society gathered 97 patients with airbag-related eye injuries reported in the medical literature from 1991 to 1998. Corneal abrasions occurred in 49% of them, hyphemas in 43%, vitreous or retinal hemorrhages in 25%, and retinal tears or detachments in 15%, and the globe was ruptured in 10 patients.

Car accidents are the most common cause of orbital rim fractures and often cause orbital floor fractures, according to Cleveland Clinic, which adds that a person with an orbital rim fracture likely has other facial fractures. Its symptom list includes blurred, double, or decreased vision, numbness, trouble moving the eye, a flattened cheek, and sunken or bulging eyeballs.

Blowout fractures may result in herniation or entrapment of orbital contents, StatPearls explains, and extraocular muscle entrapment can cause eye movement limitations, pain, double vision, optic nerve compression, and visual disturbances.

Dental Trauma From the Impact

Dental trauma is any injury to the teeth, gums, jawbone, or soft tissues of the mouth, and Cleveland Clinic names car wrecks among the main causes. The types it lists run from chipped and cracked teeth to dislodged teeth, knocked-out teeth, teeth jammed into the socket, cuts in the soft tissue, and broken or dislocated jaws.

A permanent tooth that is knocked out can sometimes be put back in place, according to MedlinePlus, though baby teeth are not replanted. Cleveland Clinic says the window to replant a knocked-out tooth is short, usually within 30 to 40 minutes, and MedlinePlus notes that a replanted tooth will most likely need a root canal.

If the upper and lower teeth cannot close together, the jaw may be broken, MedlinePlus says, and that requires medical help right away. Cleveland Clinic lists cavities, an abscessed tooth, tooth loss, pain, difficulty chewing, speech issues, changes in appearance, and lower self-esteem among the possible consequences of dental trauma.

Three Facial Injuries Side by Side

The table below lines up three common crash injuries using the Cleveland Clinic and StatPearls descriptions cited on this page.

CT Scans and Other Imaging Tests

Computed tomography (CT) is the most common imaging test used to diagnose facial fractures, according to Cleveland Clinic. MedlinePlus says an x-ray or CT scan of the head and the bones of the face may be performed after facial trauma.

For the eye socket, StatPearls calls CT the imaging modality of choice for a blowout fracture. A CT scan may show orbital fat or the inferior rectus muscle herniating into the maxillary sinus, StatPearls adds, and it can also detect hidden tears and retained foreign bodies.

A dentist may take dental x-rays or a CT scan to see the extent of a mouth injury, according to Cleveland Clinic, and Cleveland Clinic’s broken nose page says x-rays or CT scans may be used when other facial injuries are suspected.

When part of the face stops moving after a crash, StatPearls says the most common added tests are a non-contrast CT scan for temporal bone fractures and electrodiagnostic studies to determine the severity of the nerve injury.

Wound Closure and Fracture Repair

MedlinePlus describes the goals of facial trauma treatment as creating a clear airway, controlling bleeding, fixing broken bone segments, preventing scars if possible, preventing long-term double vision or sunken eyes or cheekbones, and ruling out other injuries. Surgery is done if the injury prevents normal functioning or causes a major deformity, the entry says.

Facial fracture treatment involves reduction and fixation, Cleveland Clinic explains: resetting the broken bones in their correct positions, then keeping them in place long enough to heal, sometimes with surgical plates, screws, and wires. A complex fracture with multiple broken bones calls for facial reconstructive surgery, Cleveland Clinic adds.

For more serious cuts, Cleveland Clinic lists possible treatments that include cleaning the wound and closing it with sutures, staples, adhesives, or bandages, and it says lacerations that are deep or that affect connective tissue may need surgery to repair.

Timing differs from one injury to the next. When an orbital floor fracture needs repair, StatPearls says surgery generally must be performed within 14 days of injury to prevent fibrosis, and most surgeons wait 24 to 72 hours for swelling to subside. For a broken nose that is out of alignment, Cleveland Clinic says manual realignment may be done a few days after the injury, with the packing and dressing removed in about two weeks.

Scar Maturation and Healing Time

A nasal fracture generally heals in six to eight weeks, according to Cleveland Clinic. Most people without airway blockage do very well with proper treatment, MedlinePlus reports, though more surgery may be needed in 6 to 12 months to correct changes in appearance.

Most scars need 12 to 18 months to mature, Cleveland Clinic says, and new scars don’t usually respond well to scar revision. Scars shrink and become less noticeable as they age, according to MedlinePlus, and revision may wait until the scar lightens in color, which can be several months or even a year after the wound has healed.

How much scarring forms depends on the size, depth, and location of the wound, the person’s age, and skin characteristics such as pigmentation, MedlinePlus explains. Its list of problems that may lead to revision includes keloids, thickened scars, scars at an angle to the normal tension lines of the skin, and scars that distort other features. Cleveland Clinic cautions that scar revision isn’t likely to completely remove the scar.

Nerve Damage and Lasting Complications

MedlinePlus lists the possible complications of facial trauma as a blocked airway in severe cases, bleeding, an uneven face, infection, brain and nervous system problems, numbness or weakness, and loss of vision or double vision. For cuts, Cleveland Clinic adds infection, scarring, and permanent numbness or weakness after a nerve laceration.

StatPearls reports that 31% of temporal bone fractures occur secondary to motor vehicle collisions and that facial paralysis occurs in 7 to 10% of all temporal bone fractures. Paralysis from these fractures often takes days to weeks to reach its peak, the chapter explains, because swelling inside the bony canal that carries the facial nerve may develop very slowly.

An injured axon grows back toward the muscle at a rate of approximately 1 mm per day, according to StatPearls, and beyond 12 months from the onset of paralysis the likelihood of successfully reinnervating the facial muscles decreases substantially.

Some people develop nerve pain that can last for up to nine months after an orbital fracture, Cleveland Clinic says, others have persistent double vision that could require another surgery, and enophthalmos, a sinking of the eye, may worsen with time. Most orbital fractures still heal without long-term effects, the same page notes.

Records That Track a Visible Injury

In the evaluation of facial nerve trauma, StatPearls describes photo and video documentation following the history and physical exam, and it says it may be simpler and more precise to record the findings in a detailed and systematic way that describes the function of each major facial nerve branch.

Pictures taken in the first days after the crash and at regular points afterward show how swelling, bruising, and scars changed over time. The emergency notes, CT reports, and operative reports explain what caused those changes and what was done about them.

Crash details belong in the same file. The 2009 crash study linked facial fractures to more severe impacts, so the police report, vehicle photos, and repair estimates help show the force behind the injury.