The jaw and face are among the most vulnerable areas of the body to trauma. Traffic accidents, assaults, and falls frequently cause injuries to both soft tissues and bones in this region. Looking down from above, this area includes the frontal bone (forehead bone), the orbital bones, the zygoma and its arch (cheekbone and its extension), the maxilla (upper jaw bone), and the mandible (lower jaw bone). Fractures of each of these bones present distinct clinical scenarios and require different treatment approaches.

Following trauma, the patient should be examined by a plastic surgeon as soon as possible, and the fracture should be evaluated using appropriate imaging methods. For fractures in this region, computed tomography (CT) is used as the gold standard examination method (Exception: Panoramic X-ray is considered superior to CT in the mandible). In craniofacial fractures, the presence of a fracture, as well as its displacement to the point of causing problems, particularly with vital functions such as vision and chewing, is extremely important in deciding whether to perform surgery.

Frontal bone (forehead bone) fractures typically occur after high-energy trauma and are often accompanied by other medical problems. In fractures involving only the outer layer of the frontal bone, which distort the appearance of the forehead, the bone is reshaped through an incision made under the hairline and fixed with titanium plates and screws. If there is a comminuted fracture involving the inner layer of the bone that cannot be reshaped, the surgery is performed in collaboration with neurosurgery, the inner portion of the bone is removed, and if necessary, the outer portion is reshaped.

In orbital fractures, the most important factor leading to a decision for surgery is changes related to the eye. Any change in the person’s visual function, primarily double vision and limited gaze, is considered a reason for surgery. In surgery for these fractures, incisions are usually made inside the eyelids to access the walls of the eyeball. After the fractured piece is corrected, if there is no bone deficiency, fixation is applied with titanium plates and screws. If there is a bone deficiency, especially at the base of the eyeball, the deficiency is completed using bone grafts taken from the body or with the help of a substance called Medpor.

Fractures of the cheekbone (zygoma) are primarily divided into two categories: fractures of the main body of the bone or fractures of its extension towards the front of the ear (zygoma arch). In arch fractures, there are two main findings that lead to a decision for surgery: the first is restricted mouth opening, and the second is the formation of a depression in that area. In this case, under local anesthesia and sedatives (general anesthesia is often not necessary), the arch is repositioned through an approximately 2 cm incision made under the hair. Fractures of the main body of the cheekbone require a more comprehensive operation.

In this surgery, the bone is repositioned through incisions made inside the eyelid and mouth, and secured with titanium plate screws at 2 or 3 points.

Maxillary fractures are classified into three categories based on the location of the fracture (LeFort-1, 2, and 3). The most important factor leading us to surgery in the treatment of these fractures is that they cause malocclusion. In the treatment of maxillary fractures, the surgical incision is again made from inside the mouth, and the bone is fixed with titanium plate screws, taking into account the alignment of the upper and lower jaws. After this surgery, the upper and lower jaws are connected with elastics for 2-3 weeks to ensure that the jaw heals with correct occlusion.

Treatment for mandibular fractures varies depending on the location of the fracture(s). Fractures near the temporomandibular joint are often treated surgically by simply tying the jaws together with rubber bands, as access to the area is more difficult (the facial nerve, which controls facial movements, passes near the temporomandibular joint in front of the ear). However, if this method is unsuccessful, an incision is made under the jaw and in front of the ear, and the fracture is fixed with a plate and screws.

In cases other than fractures near the temporomandibular joint, incisions are made inside the mouth to reposition the fractured segments, which are then fixed with titanium plates and screws. Following this surgery, the upper and lower jaws are kept connected with elastics for 2-3 weeks to ensure proper bite and healing.

Jaw and facial bone fractures are serious injuries that may require complex surgical procedures and carry a risk of long-term complications. After initial treatment in the emergency room, patients should be referred to a plastic surgeon for follow-up and treatment without delay.