Their broad-based and extensive dental and medical training in the hospital-based environment uniquely qualifies oral and maxillofacial surgeons to treat and repair injuries to the face, jaws, mouth and teeth.
Oral and maxillofacial surgeons are experts in treating trauma, including fractures of the upper and lower jaws and orbits, and the cosmetic management of facial lacerations. Their knowledge of how jaws come together (dental occlusion) is critical when repairing complex facial fractures. In fact, the American College of Surgeons’ guidelines for optimal care require Level I and II trauma centers—those that treat the most serious and complex facial trauma patients—to have oral and maxillofacial surgeons on call to perform complex reconstruction of the mouth, face and jaws. Dr. Meyers is on staff at our local hospitals. For nearly two decades, he has served as Chief of the Division of Oral & Maxillofacial Surgery and Dentistry for the Pinnacle Health System. He provides emergency room coverage for facial injuries, including:
- Facial lacerations
- Intra oral lacerations
- Avulsed (knocked out) teeth
- Fractured facial bones
- Fractured jaws (upper and lower jaw)
Injuries to the face, by their very nature, impart a high degree of emotional, as well as physical trauma to patients. The science and art of treating these injuries requires special training involving “hands on” experience and an understanding of how the treatment provided will influence the patient’s long term function and appearance.
Many of the techniques that are standard in today’s hospital emergency rooms were developed by oral & maxillofacial surgeons in combat hospitals during World War II, Korea, Vietnam, the Gulf war and today’s international conflicts.
Trauma does not only result from major events like combat or automobile accidents. Childhood injuries caused by skateboards, sports or bicycle accidents frequently involve dental or maxillofacial trauma. Younger children often sustain damage to teeth or supporting structures from falls. Such traumatic injuries can usually be effectively treated in the CPOMS office, avoiding costly emergency room visits. Various safe and effective sedation techniques can be employed to deliver prompt, comfortable and successful treatment in the office setting.
The Nature of Maxillofacial Trauma
There are a number of possible causes of facial trauma. Motor vehicle accidents, accidental falls, sports injuries, interpersonal violence and work related injuries account for many. Types of facial injuries can range from injuries of teeth to extremely severe injuries of the skin and bones of the face. Typically, facial injuries are classified as soft tissue injuries (skin and gums), bony injuries (fractures), dental injuries, or injuries to special regions (such as the eyes, facial nerves or the salivary glands).
Soft Tissue Injuries of the Maxillofacial Region
When soft tissue injuries such as lacerations occur on the face, they usually are repaired by “suturing.” In addition to the obvious concern of providing a repair which yields the best cosmetic result possible, care is taken to inspect for and treat injuries to structures such as facial nerves, salivary glands and salivary ducts (or outflow channels). Dr. Meyers is a well-trained oral and maxillofacial surgeon and is proficient at diagnosing and treating all types of facial lacerations.
Bone Injuries of the Maxillofacial Region
Fractures of the bones of the face are treated in a manner similar to the fractures in other parts of the body. The specific form of treatment is determined by various factors, which include the location of the fracture, the severity of the fracture, and the age and general health of the patient. When an arm or a leg is fractured, a “cast” is often applied to stabilize the bone and allow for proper healing. Since a cast cannot be placed on the face, other means have been developed to stabilize facial fractures.
One of these options involves wiring the jaws together for certain fractures of the upper and/or lower jaw. However, certain other types of fractures of the jaw sometimes are best treated and stabilized by the surgical placement of small “plates and screws” at the involved site. Such treatment can often allow for healing and may eliminate the necessity of having the jaws wired together. This technique is called “rigid fixation” of a fracture. The relatively recent development and use of “rigid fixation” has profoundly improved the recovery period for many patients by allowing them to return to normal function more quickly.
The treatment of facial fractures should affect the patient’s facial appearance as minimally as possible. Dr. Meyers tries to access the facial bones through the fewest incisions necessary. At the same time, the necessary incisions are designed to be small and, whenever possible, are placed so that the resultant scar is “hidden” as well as possible.
Injuries to the Teeth and Surrounding Dental Structures
Isolated injuries to teeth are quite common and may require the expertise of various dental specialists. Oral surgeons usually are involved in treating fractures in the supporting bone or in replanting teeth which have been displaced or “knocked out”. These types of injuries are treated by one of a number of forms of “splinting” (stabilizing by wiring or bonding teeth together with a plastic-like material). If a tooth is “knocked out”, it should be placed in salt water or milk. The sooner the tooth is re-inserted into the dental socket, the better the chance for the survival of the tooth.
Therefore, the patient should see a dentist, endodontist or oral surgeon as soon as possible. Never attempt to “wipe the tooth off” because remnants of the ligament which hold the tooth in the jaw are attached and are vital to the success of replanting the tooth. Other dental specialists may be called upon such as endodontists, who may be asked to perform root canal therapy, and/or restorative dentists who may need to repair or rebuild fractured teeth. In the event that injured teeth cannot be saved or repaired, dental implants often are utilized as replacements for missing teeth when the patient is old enough.
The proper treatment of facial injuries is now the realm of specialists, well versed in the emergency care, acute treatment and long term reconstruction and rehabilitation of the patient.
“An Ounce of Prevention…”
Because avoiding injury is always best, Dr. Meyers and the CPOMS Team advocate the use of automobile seat belts, protective mouth guards, and appropriate masks and helmets for everyone who participates in athletic pursuits at any level. You don’t have to play at the professional level to sustain a serious head injury. New innovations in helmet and mouth and face guard technology have made these devices comfortable to wear and very effective in protecting the vulnerable maxillofacial area. Make sure your family is well-protected. If you play the sport, make appropriate safety gear part of your standard athletic equipment.
- Football: Helmets with face guards and mouth guards should be worn. Many of the helmets manufactured for younger players have plastic face guards that can be bent back into the face and cause injury. These should be replaced by carbon steel wire guards.
- Baseball: A catcher should always wear a mask. Batting helmets with a clear molded plastic face guard are now available; these can also be worn while fielding.
- Ice Hockey: Many ice hockey players are beginning to wear cage-like face guards attached to their helmets. These are superior to the hard plastic face masks worn by some goalies, as the face guard and the helmet take the pressure of a blow instead of the face. For extra protection, both face and mouth guards—including external mouth guards made of hard plastic and secured with straps—can be worn.
- Wrestling: More and more high school athletic associations require wrestlers to wear head gear. A strap with a chin cup holds the gear in place and helps steady the jaw. Recently, face masks have been developed for wrestlers, who should also wear mouth guards.
- Boxing: Mouth guards are mandatory in this sport. A new pacifier-like mouth guard for boxers has been designed with a thicker front, including air holes to aid breathing.
- Lacrosse: Hard plastic helmets resembling baseball batting helmets, with wire cage face masks, are manufactured for this sport.
- Field Hockey: Oral and maxillofacial surgeons recommend that athletes participating in this sport wear mouth guards. Goalies can receive extra protection by wearing Lacrosse helmets.
- Soccer: Soccer players should wear mouth guards for protection. Oral and maxillofacial surgeons advise goalies to also wear helmets.
- Biking: All riders should wear lightweight bike helmets to protect their heads.
- Scooters and Skateboarders: Bike helmets are also recommended for those who ride two-wheeled scooters and skateboards.
- Skiing and Snowboarding: The recent surge in accidents among skiers and snowboarders has encouraged many safety conscious participants to wear lightweight helmets that will protect the maxillofacial area in the event of a fall or crash.
- Horseback Riding: A helmet and mouth guard are recommended for horseback riding, particularly if the rider is traveling cross-country or plans to jump the horse.
- Basketball, Water Polo, Handball, Rugby, Karate, Judo, and Gymnastics: Participants in these sports should be fitted with mouth guards.
New synthetic materials and advances in engineering and design have produced mouth guards that are sturdier yet lightweight enough to allow the wearer to breathe easily. Mouth guards can vary from the inexpensive “boil and bite” models to custom-fabricated guards, which can be adapted to the sport and are generally more comfortable.
A mouth guard should be durable, comfortable and tear-resistant and provide protection to the teeth, gums and lips. When wearing a mouth guard, the athlete should be able to speak and breathe easily.
When being fitted for a mouth protector, remember the device should be:
- fitted so that it does not misalign the jaw and throw off the bite;
- strong; and
- easy to clean.
In the event a facial or mouth injury occurs that requires a trip to the emergency room, the injured athlete, a parent or coach should be sure to ask that an oral and maxillofacial surgeon is called for consultation. With their background and training, oral and maxillofacial surgeons are the specialists most qualified to deal with these types of injuries. In some cases, they may even detect a “hidden” injury such as a jaw fracture that might otherwise go unnoticed.