Can you really break a face?

Wednesday, April 7, 2010

Basketball once was considered a non contact sport but as bodies got bigger, faster and stronger, even a 94 foot long court seems small and the space under basket even smaller. Chris Bosh, a player for the NBA Toronto Raptors, fractured his face when hit by a flying in elbow, proving a variety of physics laws including the one that reminds us that two objects can’t occupy the same space at the same time.

There are a variety of facial bones that make up the front part of the head and not only give the fountain for how our face will look but also house functions that help with breathing, seeing, smelling and chewing. The face is constructed to afford much protection to the organs it protects. The forehead (frontal bone) and cheek bones (maxilla) not only protect the eyes but also contain the sinuses that act like air bags to protect the front part of the brain. The sinuses have a variety of other jobs as well, including humidifying air and giving resonance to the voice. The nasal bones are commonly broken only because they stick out in front and people often lead with their faces when they fall or trip.

The treatment of facial fractures depends upon which bone or combination of bones is broken, where it’s broken and whether it affects the associated structure that it protects. Usually, a facial surgeon gets involved and there are numerous types that can fix his terrain: oral surgeon and maxillofacial surgeons are specially trained to care for traumatic injuries; plastic surgeons are either general surgeons or otolaryngologists (ENT surgeons) who have taken extra training. Sometimes, no treatment is needed except for ice, pain control and time.

Nose fractures happen routinely and end to be dramatic because they bleed a lot. Once the bleeding is stopped, most of the decision making about treatment can wait a few days until the swelling goes down and the cosmetics of the nose can be assessed. If the nose looks good and the septum is not deviated, then nature can do the healing but if there is a cosmetic problem, for example, the nose is pushed to one side of the face or splayed at the bridge, it can often be fixed by a small office procedure.

Maxillary or cheekbone fractures become an issue if the thin bone below the eye (the inferior orbital rim) breaks and causes the eyeball to sag into the sinus underneath it. Actually, it’s not the eyeball that sags but rather the fat and muscle that help support the eye. It becomes entrapped and prevents the eye from moving causing double vision. This fracture may also heal on its own but sometimes needs an operation to repair the orbit floor and preserve eye motion.

Fracture of the zygoma (part of this bone includes the arch that protects the outside part of the eye) may or may not need fixing depending upon what other bones are also involved.

Isolated bone fractures are all fixable but are not the big worries. Combination fractures can cause enough swelling and bleeding to obstruct the upper airways and cause life threatening situations. The LeFort classification (I,II,III) describes what bones are involved; the severity of injury increases with the high we number. A Lefort III fracture describes the situation where the face is dislocated from the skull.

While facial fractures are diagnosis clinically and by plain x-rays, CT scan is often used to help locate al the broken bones and 3D reconstruction views make it even easier to figure out what goes where and if surgery is needed to help. Otherwise time heals all and as long as function is maintained, there is little need to rush into surgery. Fixing the face usually requires small metal plates, screws and wires to keep the bones from moving while they heal. Think of tiny erector set parts that hold the bones in place.

Most people who fall or get hit in the face don’t need to get an x-ray or even see a doctor, but when two 7-foot giants collide on the basketball court, sometimes it’s the bones that have got to give.

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