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Diagnosis and treatment of fractures and injuries of the facial bones and jaws, with the aim of restoring function and anatomy.
Facial trauma surgery deals with injuries to the bones and tissues of the face caused by accidents, falls, sport or assault. The facial skeleton protects sensitive structures and supports essential functions such as chewing, breathing, vision and speech.
Treatment aims to restore the anatomy and the occlusion the patient had before the injury and, with them, function.
Facial trauma should be assessed when there is persistent pain, a change in the bite, difficulty or blockage on opening the mouth, altered facial sensation, double vision or an asymmetry that was not present before.
An acute facial injury is an emergency and must be treated in a hospital setting; specialist assessment then allows the definitive treatment to be defined.
Clinical examination is complemented by imaging, usually computed tomography, which identifies the fracture line, the displacement of the fragments and the involvement of adjacent structures.
Documenting the pre-injury occlusion, when it can be reconstructed, is key to guiding fracture reduction.
Not every fracture requires surgery. When it is indicated, treatment usually consists of reducing the fragments and fixing them with osteosynthesis material, re-establishing the relationship between the jaws.
In complex fractures or in sequelae that have already healed, three-dimensional planning helps define the repositioning of the fragments and, where appropriate, the design of specific reconstructions.
When an injury is treated incompletely or late, changes in the bite, asymmetries or limited mouth opening may persist. These sequelae are addressed individually and may require reconstructive procedures.
Subsequent follow-up assesses bone healing, masticatory function and the recovery of sensation, which may be gradual.
Oral surgery comprises surgical procedures performed mainly on teeth, oral cavity tissues and dentoalveolar structures, such as certain complex extractions, impacted teeth, biopsies and other procedures.
Oral and maxillofacial surgery additionally covers conditions and treatments affecting the facial skeleton and structures. Its scope includes dentofacial deformities, facial trauma, maxillofacial reconstruction, jaw pathology and certain temporomandibular joint disorders, in addition to oral surgery procedures.
For the patient, the relevant distinction is essentially clinical. A complex tooth extraction, a deformity affecting the overall position of the jaws, and a mandibular reconstruction represent problems of very different nature and complexity.
The diagnosis determines what type of procedure and what level of planning are needed in each situation.
Planning can integrate clinical examination, photographs, radiographic studies, CBCT (cone beam computed tomography), intraoral scans and three-dimensional models. The information required depends on the procedure and the anatomical complexity of the case.
In certain surgeries it is possible to build a virtual representation of the facial skeleton and dentition. On this model, asymmetries can be studied, measurements taken, osteotomies simulated, and planned movements analyzed before entering the operating room.
In complex reconstructions, the position of bone segments, the design of certain surgical guides, or the relationship between the reconstruction and a future rehabilitation can also be planned.
These tools increase the amount and precision of available information, but they do not replace diagnosis or surgical experience. Digital planning is useful when it serves a correctly indicated clinical strategy.
Cone beam computed tomography, known as CBCT, is an imaging technique that provides three-dimensional information about the bony structures of the maxillofacial region.
Unlike a conventional radiograph, which represents three-dimensional structures in a two-dimensional image, a CBCT allows analysis of slices and reconstructions in different planes. It can provide information on impacted teeth, available bone, anatomical relationships, the maxilla, mandible, joints and other structures, depending on the clinical indication.
It can also be used as part of certain virtual planning workflows.
Not every patient or procedure requires a CBCT. As with any radiological examination, there must be a valid indication justifying its use. The choice of imaging test depends on the diagnostic information needed and should balance clinical usefulness against radiation exposure.
Preoperative assessment begins by determining whether there is an adequate indication for the procedure and whether the expected benefits justify its risks. The specific characteristics of the procedure and the patient are then studied.
The evaluation may include medical history, current medication, allergies, prior surgical history, physical examination, imaging tests and preoperative studies. Depending on the procedure and the patient's condition, additional assessments may be necessary.
Risks are not the same for all surgeries. Aspects that may be assessed include bleeding, infection, sensory disturbances, healing, bone stability, occlusal problems and anesthetic risks, in addition to complications specific to each procedure.
Adequate informed consent does not consist merely of signing a document: it requires understanding the indication, the reasonable alternatives, the limitations and the relevant risks of the proposed treatment.
There is no single recovery time that applies to all maxillofacial surgery. A dentoalveolar procedure, orthognathic surgery and extensive facial reconstruction have very different postoperative courses.
It is also worth distinguishing between several stages: initial recovery, reduction of swelling, tissue consolidation and a gradual return to usual activities. Patients may be functionally recovered well before the biological healing process has fully concluded.
The time required depends on the procedure performed, its extent, the patient's characteristics and postoperative progress. Diet, oral hygiene, physical activity and return to work may also require different recommendations.
For this reason, recovery times published online should be understood only as general references. A useful estimate can only be given once the specific intervention being considered and the individual clinical circumstances are known.
3D virtual planning makes it possible to analyze anatomy, simulate procedures and accurately transfer the plan to the operating room, without replacing the surgeon's judgment.
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