Facial Trauma

Most facial fractures should be evaluated the same day as the injury. Definitive surgical repair is ideally performed within 7–10 days, before significant scar tissue forms. Nasal septal haematoma must be drained within 24–48 hours to prevent septal necrosis. Orbital fractures with significant diplopia or enophthalmos should be repaired within 2 weeks. Delay beyond 2–3 weeks makes surgical correction technically more difficult.

Most modern facial fracture surgery is performed through incisions placed inside the mouth (intraoral approach) or in natural skin creases and hairline. This minimises visible scarring. Orbital fractures may be accessed through a lower eyelid incision, placed in the natural crease, which heals with minimal visible scar. The goal is always functional restoration with minimum aesthetic compromise.

Facial fractures are repaired using titanium miniplates and screws (open reduction and internal fixation — ORIF). Titanium is biocompatible and the plates are left in permanently in most cases. Removal is only needed if plates cause localised infection, palpable discomfort, or interfere with subsequent treatment. Most patients are never aware of the plates once healed.

An undisplaced zygomatic fracture with no functional deficit (no restricted mouth opening, no diplopia) can sometimes be managed conservatively. However, a displaced fracture — causing flattening of the cheek, restricted mouth opening, or diplopia — requires surgical repair. Left untreated, facial asymmetry becomes permanent as the bone heals in a malposition, and functional problems persist.