Maxillofacial Trauma Surgery for Facial, Jaw, and Soft Tissue Injuries

The term “maxillofacial” refers to the anatomical region comprising the facial skeleton and its associated soft tissues, including the upper jaw (maxilla), lower jaw (mandible), cheekbones (zygomatic bones), nasal bones, and the orbital cavities. This region contains essential structures of the respiratory and digestive tracts, along with major sensory nerves, vascular networks, and the muscles responsible for chewing (mastication), facial expression, and speech.

Given the density and complexity of these anatomical structures, even relatively minor injuries to the maxillofacial area can have significant consequences. Functional impairments—such as difficulty breathing, chewing, speaking, or maintaining proper eye alignment—are common in facial trauma. Moreover, because the face plays a central role in identity and social interaction, preserving or restoring aesthetic appearance is often as important as restoring function.

Maxillofacial trauma surgery is a vital subspecialty within oral and maxillofacial surgery that focuses on the assessment, surgical correction, and rehabilitation of injuries to the facial skeleton and surrounding tissues. These cases often require a high degree of surgical precision and coordination among multiple specialties due to the region’s anatomical and functional complexity.

Without prompt and appropriate intervention, patients may suffer long-term consequences such as chronic pain, bite misalignment (malocclusion), impaired speech or swallowing, nerve damage, and permanent facial disfigurement.

Why Cuba

Surgical management of maxillofacial trauma in Cuba is guided by core principles aimed at restoring anatomical structure and function while minimizing the risk of complications. These principles include achieving precise realignment of fractured bone segments, preserving critical neurovascular structures, maintaining soft tissue integrity, and preventing infection or long-term deformity. Cuban surgical teams adhere to evidence-based protocols and benefit from specialized training in oral and maxillofacial trauma, allowing for effective and timely intervention, even in complex cases involving multiple fracture sites or soft tissue injuries.

The objectives of maxillofacial trauma surgery in Cuba go far beyond immediate stabilization. Surgeons prioritize functional restoration ensuring the patient can chew, speak, breathe, and express emotion naturally. Equal emphasis is placed on aesthetic outcomes, recognizing the importance of facial symmetry and appearance in social reintegration and psychological recovery. Postoperative care typically includes comprehensive rehabilitation, which may involve physical therapy, dental reconstruction, speech therapy, or psychological support.

Furthermore, Cuba’s integrated healthcare system supports multidisciplinary collaboration, where maxillofacial surgeons work closely with anesthesiologists, ENT specialists, neurologists, prosthodontists, and mental health professionals. This approach enhances the patient’s chances of a full recovery—physically, emotionally, and socially—and ensures that surgical treatment is not an isolated event but part of a broader continuum of care that promotes long-term well-being and reintegration into daily life.

IMPORTANT TO NOT: IF THE BELOW COMPLICATIONS ARISE, URGENT MEDICAL CARE IS REQUIRED.

• Airway obstruction
• Hemorrhage control
• Orbital injuries with compromised vision
• Open fractures with infection risk

Common Types of Facial or Jaw Fractures

Maxillofacial trauma may involve one or more of the following types of fractures:

• Mandibular fractures (lower jaw)
• Maxillary fractures (upper jaw)
• Zygomatic arch fractures (cheekbone)
• Orbital floor fractures (eye socket)
• Nasal bone fractures
• Panfacial fractures, involving multiple facial bones simultaneously

Types and Classification

Facial fractures can be classified by:

• Location: Mandible, maxilla, zygoma, orbit, nasal bones
• Complexity: Simple (non-displaced), compound (with soft tissue involvement), comminuted (multiple fragments)
• Pattern: Linear, oblique, transverse, greenstick (in children)
• Open vs. closed fractures: Whether the skin or mucosa is penetrated

Causes of Maxillofacial Trauma

Maxillofacial trauma can result from a wide range of incidents, many of which involve high-impact or blunt force injuries to the face and jaw. The most common causes include:

• Motor vehicle accidents
• Falls, especially in children and elderly
• Physical assault
• Sports-related injuries
• Industrial or occupational accidents
• Firearm or penetrating trauma

Symptoms of Maxillofacial Trauma

Symptoms of maxillofacial trauma can vary depending on the location and severity of the injury but often present with noticeable changes in function, sensation, and appearance. Common signs include:

• Facial swelling and bruising
• Pain and tenderness
• Malocclusion (misaligned bite)
• Numbness or tingling (nerve injury)
• Visible deformity or asymmetry
• Difficulty opening the mouth or speaking
• Bleeding from the nose, mouth, or wounds

Presurgical Diagnosis for Maxillofacial Trauma

The purpose of presurgical diagnosis is to confirm the exact nature and extent of the injury or condition, identify any underlying risk factors, and develop a safe, effective, and individualized surgical plan.

Medical and Dental History

• Review of past medical conditions, surgeries, and medications
• Allergies, bleeding disorders, and systemic diseases (e.g., diabetes)
• History of dental trauma or previous maxillofacial surgeries

Clinical Examination

• Extraoral assessment for facial symmetry, swelling, bruising, skin lacerations, jaw movement
• Intraoral assessment for teeth alignment, occlusion (bite), mucosal integrity, dental injuries, step deformities
• Neurological screening to check for sensory loss, motor deficits, or cranial nerve involvement

Radiographic Imaging

• Panoramic X-ray (OPG) to assess jaw fractures, tooth roots, and mandibular canal
• Facial CT scan or Cone Beam CT (CBCT) for precise fracture mapping and soft tissue assessment
• Orbital or midface CT to evaluate complex fractures and orbital floor integrity

Functional Assessments

• Jaw mobility and bite function
• Ocular examination including vision testing if orbital trauma is suspected
• Airway assessment in cases with swelling or complex facial fractures

Laboratory Tests (as needed)

• Complete blood count (CBC)
• Coagulation profile (especially if bleeding is a concern)
• Blood glucose, renal function, or other tests based on systemic health

Multidisciplinary Evaluation (if required)

• Ophthalmology: for orbital or ocular trauma
• Neurosurgery: if cranial involvement is suspected
• ENT: for nasal, sinus, or airway injuries
• Anesthesiology: for pre-op clearance, especially in complex or high-risk patients

Surgical Treatment for Maxillofacial Trauma

Maxillofacial trauma surgery involves a range of procedures designed to address both bony and soft tissue injuries of the face. Surgical interventions may be performed under local anesthesia, sedation, or general anesthesia, depending on the complexity and location of the injury. Techniques include:

• Open Reduction and Internal Fixation (ORIF): Surgical exposure of the fracture and stabilization using titanium plates and screws
• Closed Reduction: Non-surgical manipulation and stabilization, often using splints or wiring
• Soft Tissue Repair: Suturing of facial lacerations, nerve repairs, and tissue repositioning

Below is a breakdown of common traumatic conditions, along with the typical surgical interventions, approaches used, and the level of invasiveness:

• Fractured Mandible, Maxilla, Zygomatic Arch, and Orbit
  • These types of fractures are usually carried out by Open Reduction and Internal Fixation (ORIF) procedure using titanium plates and screws
  • The procedure involves exposing the fracture, realigning it and then stabilizing with fixation hardware to restore function and symmetry
  • Surgical approach is typically open surgery due to the need for direct visualization and hardware placement

• Dislocated Jaw (Temporomandibular Joint Dislocation)
  • Jaw dislocation is performed by manual reduction or surgical stabilization
  • For acute dislocations, manual repositioning under sedation is typically performed. Chronic or recurrent dislocations may require joint capsule tightening or surgical repositioning
  • For manual reduction minimally invasive is usually preferred while open surgery may be necessary for structural repair or reconstruction

• Complex Dental Trauma (Avulsed or Intruded Teeth)
  • For these types of trauma reimplantation, splinting, or surgical repositioning may be required.
  • Avulsed teeth are cleaned and reimplanted into the socket, followed by splinting adjacent teeth. Intruded teeth may be repositioned surgically or allowed to re-erupt based on root development
  • Typically, minimally invasive approach is performed under local anesthesia

• Lacerations Involving Facial Nerves, Ducts, or Arteries
  • These conditions require microvascular or microsurgical repair of nerves, ducts (e.g., parotid), and arterial ligation or anastomosis
  • Delicate layered closure is performed under magnification, with nerve or duct repair using microsutures
  • Surgical approach is usually open surgery with microsurgical techniques is required due to anatomical precision

• Bone Defects Following Trauma or Infection
  • These conditions are treated with bone grafting or reconstructive surgery using autogenous grafts or alloplastic materials
  • The procedure involves filling the defects with harvested bone (commonly from the iliac crest or rib) or synthetic grafts, sometimes combined with fixation hardware
  • Open surgery is required for access and proper contouring of the reconstruction

• Orbital Blowout Fractures Causing Vision Disturbance
  • These types of fractures require orbital floor reconstruction with titanium mesh or resorbable implants
  • The orbital contents are gently repositioned, and the floor is repaired to restore ocular symmetry and prevent entrapment of soft tissue
  • Typically, the procedure is carried out via minimally invasive method, using transconjunctival or endoscopic approaches when possible; open surgery may be used in complex cases

Soft Tissue Repair After Facial Trauma

Soft tissue injuries such as lacerations, abrasions, and avulsions are common in facial trauma. Surgical repair aims to restore the natural contour and function of the affected area. This may involve delicate closure techniques, microsurgical repair of nerves or ducts, and debridement of devitalized tissue. Timely repair is critical to minimize scarring and restore facial harmony.

Reconstruction of Bone Defects After Trauma

Reconstructive surgery may be necessary when facial trauma leads to bone loss or irregular healing. Techniques may involve the use of autogenous bone grafts, alloplastic materials, or custom-fabricated implants to restore structural integrity and facial symmetry. In complex cases, computer-assisted planning and 3D printing may aid in precise reconstruction.