What This Guide Covers and Who It Is For
This guide explains how oral surgeons diagnose and repair broken bones in the face. It is written for patients and caregivers dealing with a facial injury.
Facial trauma can result from car accidents, falls, sports collisions, workplace injuries, or physical altercations. The face contains over a dozen bones that protect the brain, eyes, sinuses, and airway. When these bones break, a specialist trained in facial anatomy is often needed to restore both function and appearance.
Oral and maxillofacial surgeons (OMS) are dentists who complete an additional four to six years of hospital-based surgical residency after dental school. [3] During this training, they work alongside medical residents in emergency departments, trauma centers, and operating rooms. This background makes them uniquely qualified to manage injuries involving the jaw, cheekbones, eye sockets, and surrounding soft tissues.
Whether you are preparing for scheduled fracture repair or helping a family member understand their treatment options, this guide covers what you need to know. You can learn more about the specialty on the oral-surgery page.
Understanding Facial Fractures
Facial fractures are breaks in any of the bones that form the structure of the face. The type, location, and severity of the fracture determine what treatment is needed.
Common Types of Facial Fractures
Facial bones vary in thickness and strength. Some break more easily than others due to their position and structure.
The nasal bones are the thinnest bones in the face and the most frequently fractured. A direct blow to the nose can cause displacement, breathing difficulty, and cosmetic changes. Nasal fractures are sometimes managed by an ear, nose, and throat specialist, but oral surgeons also treat them when other facial bones are involved.
The mandible, or lower jaw, is the second most commonly fractured facial bone. It can break in multiple places at once because of its horseshoe shape. Common fracture sites include the angle of the jaw near the wisdom teeth, the body of the jaw below the premolars, and the condyle, which is the joint where the jaw meets the skull. A broken jaw typically causes pain, difficulty opening the mouth, misalignment of the teeth, and numbness in the lower lip.
Zygomatic fractures involve the cheekbone and the bony arch that extends toward the ear. These fractures can cause a flattened appearance of the cheek, limited jaw opening, and numbness in the cheek or upper teeth. Orbital floor fractures, sometimes called blowout fractures, occur when a blow to the eye pushes through the thin bone beneath the eyeball. [2] Symptoms may include double vision, sunken appearance of the eye, and restricted eye movement. These injuries require prompt evaluation to prevent permanent vision problems. [2]
- Nasal fractures: Most common facial fracture. May cause breathing obstruction and visible deformity.
- Mandible fractures: Often break in two locations simultaneously. Affect bite alignment and jaw movement.
- Zygomatic (cheekbone) fractures: Can restrict jaw opening and cause facial asymmetry.
- Orbital floor fractures: Risk of double vision and eye muscle entrapment. [2]
- Le Fort fractures: Complex midface fractures classified as Type I, II, or III based on the pattern. These are serious injuries typically caused by high-speed impacts.
- Frontal bone (forehead) fractures: May involve the sinuses and require collaboration with a neurosurgeon.
Common Causes of Facial Trauma
Motor vehicle accidents are the leading cause of severe facial fractures. The force of impact can break multiple bones at once and cause soft tissue lacerations.
Falls are another frequent cause, especially in older adults and young children. Sports injuries account for a significant portion of facial fractures in younger patients, particularly in contact sports such as football, basketball, hockey, and martial arts. Wearing properly fitted mouthguards and face shields can reduce the risk of these injuries. [4]
Physical altercations and workplace accidents round out the most common causes. In some cases, underlying conditions such as osteoporosis or previous surgery can make facial bones more vulnerable to fracture.
How Facial Fractures Are Diagnosed
Diagnosis begins with a physical examination and imaging. The surgeon evaluates swelling, bruising, bone alignment, nerve sensation, eye movement, and bite function.
A CT scan (computed tomography) is the standard imaging tool for facial fractures. It creates detailed cross-sectional images that reveal the exact location and pattern of the break. Plain X-rays may be used for simple mandible fractures, but CT imaging provides far more information for surgical planning. In cases involving the eye socket, the surgeon may request an ophthalmology consultation to assess vision and eye muscle function before proceeding with repair. [2]
What You Need to Know Before Treatment
The timing of surgery, your overall health, and the severity of the fracture all influence treatment decisions and outcomes.
Why Timing Matters
Most facial fractures are best repaired within one to two weeks of the injury. Bones begin to heal in their displaced position relatively quickly, making later correction more difficult.
In the first few days after injury, significant swelling often makes surgery impractical. Surgeons typically wait for swelling to decrease enough to allow accurate assessment and surgical access. However, certain situations require more urgent intervention. An orbital fracture with muscle entrapment, for example, may need repair within days to prevent permanent double vision. [2] A displaced mandible fracture that blocks the airway also requires immediate attention.
If several weeks pass before treatment, the surgeon may need to re-break partially healed bone to achieve proper alignment. This adds complexity, increases surgical time, and may affect the final outcome.
Surgical vs. Non-Surgical Treatment
Not every facial fracture requires surgery. Stable, non-displaced fractures, meaning the bone is cracked but still in its correct position, may heal with observation, a soft diet, and activity restrictions.
Fractures that are displaced, unstable, or affect function typically require open reduction and internal fixation (ORIF). In this procedure, the surgeon repositions the bone fragments and secures them with small titanium plates and screws. These plates are usually left in place permanently and are well tolerated by the body. In some cases, the surgeon may use resorbable (dissolvable) plates instead.
Closed reduction is another option for certain fractures. The surgeon realigns the bone without making an incision, using manual pressure or instruments inserted through the nose or mouth. This approach is most common for simple nasal fractures and some zygomatic fractures.
For mandible fractures, another technique called maxillomandibular fixation (MMF) may be used. The surgeon wires or elastics the upper and lower jaws together to hold the broken bone in alignment while it heals. This approach is less common today due to advances in plate fixation, but it remains appropriate in certain situations.
Preparing for Surgery
Your surgeon will provide specific instructions based on your procedure and anesthesia plan. General preparation guidelines include the following.
Stop eating and drinking at least eight hours before general anesthesia, or as directed. Tell your surgeon about all medications you take, including blood thinners, supplements, and over-the-counter drugs. Some medications may need to be paused before surgery. Arrange for someone to drive you home and stay with you for the first 24 hours. Stock your home with soft foods, ice packs, and any prescribed medications before the procedure.
What to Expect During and After Surgery
Facial fracture repair is performed under general anesthesia in a hospital or surgical center. Here is a step-by-step overview of the process.
During the Procedure
Once you are under anesthesia, the surgeon accesses the fracture site. For mandible and midface fractures, incisions are often made inside the mouth. This approach avoids visible scars on the face. When external incisions are necessary, the surgeon places them in natural skin creases or along the lower eyelid margin to minimize visible scarring.
The surgeon carefully moves the bone fragments back into their correct positions. Small titanium plates, typically 1 to 2 millimeters thick, are contoured to fit the bone surface and secured with tiny screws. In orbital floor fractures, the surgeon may place a thin implant sheet made of titanium mesh or porous polyethylene to support the eye and replace the missing bone.
The procedure can take anywhere from one to four hours depending on the number and complexity of fractures. Multiple fractures or fractures in difficult locations may take longer. After the bone is stabilized, the surgeon closes the incisions with dissolvable sutures inside the mouth or fine sutures on the skin.
The First Week After Surgery
Swelling and bruising peak at about 48 to 72 hours after surgery and then gradually improve. Applying ice packs for 20 minutes on, 20 minutes off during the first two days helps control swelling.
Pain is managed with prescribed medications. Your surgeon may prescribe a combination of anti-inflammatory drugs and short-term opioid pain relievers. A multimodal approach to pain control, which combines different types of medications to reduce the need for opioids, is considered current best practice in oral and maxillofacial surgery. [5] Effective pain management is an important part of recovery and should be discussed openly with your surgical team. Antibiotics are typically prescribed for one week to prevent infection at the surgical site.
You will be on a soft or liquid diet for the first one to two weeks. Avoid chewing on the side of the fracture. Keep your head elevated, even during sleep, to reduce swelling. Avoid blowing your nose if you have a midface or orbital fracture, as this can force air into the tissues around the eye.
Weeks 2 Through 8 and Beyond
Most patients return to desk work or light activity within one to two weeks. Physical labor and contact sports are typically restricted for six to eight weeks, or until the surgeon confirms adequate bone healing.
Bone healing takes approximately six to eight weeks in most cases. Full soft tissue recovery, including resolution of numbness, may take several months. Some patients experience temporary or, less commonly, permanent numbness in areas supplied by nerves near the fracture. The inferior alveolar nerve (which gives feeling to the lower lip and chin) and the infraorbital nerve (which gives feeling to the cheek and upper lip) are the most commonly affected.
Follow-up appointments typically occur at one week, four weeks, and three months after surgery. The surgeon will monitor healing with physical exams and sometimes repeat imaging. Hardware removal is rarely needed, but may be considered if a plate causes discomfort or becomes infected.
Cost of Facial Fracture Surgery
The total cost of facial fracture repair typically ranges from $3,000 to $25,000 or more. Costs vary by location, provider, and case complexity.
Several factors influence the final cost. These include the number and location of fractures, whether the surgery is performed in a hospital or outpatient surgical center, the type of anesthesia, the cost of titanium hardware, and any additional imaging or consultations. A simple closed reduction of a nasal fracture is at the lower end of the range. Repair of multiple complex fractures under general anesthesia in a hospital setting is at the higher end.
Medical insurance, rather than dental insurance, typically covers facial fracture surgery when the injury results from trauma. Coverage varies by plan. Contact your insurance provider before surgery to understand your benefits, deductibles, and any pre-authorization requirements. If the injury occurred in a car accident, auto insurance medical coverage may also apply.
Ask your surgeon's office for a detailed cost estimate that includes surgeon fees, facility fees, anesthesia fees, and hardware costs. Some offices offer payment plans for out-of-pocket expenses.
When to See an Oral and Maxillofacial Surgeon
Any suspected facial fracture should be evaluated by a specialist trained in facial bone surgery. Early assessment leads to better treatment options and outcomes.
Go to an emergency room immediately if you experience any of the following after a facial injury: difficulty breathing, heavy bleeding that does not stop, a visible shift in your jaw or teeth, double vision or inability to move your eye normally, clear fluid draining from your nose (which may indicate a skull base fracture), or loss of consciousness at any point.
For less acute injuries, see an oral and maxillofacial surgeon within a few days if you notice persistent pain, swelling that worsens after 48 hours, numbness in the lip, cheek, or chin, difficulty opening your mouth, or a change in how your teeth fit together when you bite down. A general dentist can provide an initial assessment and referral, but the surgical evaluation and treatment plan should come from a specialist trained in facial trauma. [3]
Orbital fractures deserve special mention. If you have swelling around the eye, restricted eye movement, or double vision after a blow to the face, seek evaluation promptly. Delays in treating an orbital fracture with muscle entrapment can lead to permanent eye movement problems. [2]
- Emergency signs: Airway obstruction, uncontrolled bleeding, clear nasal drainage, loss of consciousness.
- Urgent signs: Double vision, inability to move the eye, severe jaw displacement.
- Non-emergency but important: Persistent facial pain, worsening swelling, numbness, bite changes, limited jaw opening.
Find a Facial Trauma Specialist Near You
If you or a family member has suffered a facial injury, an oral and maxillofacial surgeon can evaluate the damage and recommend the right treatment. Visit the oral-surgery page to search for a qualified specialist in your area and learn more about what these surgeons do.
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