Initial assessment and management of maxillofacial trauma

Arrange urgent transfer to an emergency department for a patient with any of the following:

  • loss of consciousness
  • airway compromise
  • uncontrolled bleeding
  • significant eye injury (eg orbital swelling, proptosis, vision loss).

See Basic life support flow chart for the basic life support flowchart.

Although some patients with minor injuries to the mandible (lower jaw), zygomatic complex (cheekbone) and nose may look reasonably well at presentation, all patients require thorough assessment. Patients presenting with significant maxillofacial trauma should undergo a formal primary and secondary trauma survey in hospital.

For all patients with maxillofacial trauma, ensure that tetanus immunisation is up-to-date (see Requirement for tetanus prophylaxis for the requirement for tetanus immunisation).

Account for all dental fragments, dentures or other restorations.

Debride any soft tissue injuries. Soft tissue injuries that require operative care by an appropriate specialist include:

  • significant lacerations of the gums
  • significant lacerations of the lip or vermillion border
  • degloving injuries (where the bone has been exposed).

To ensure there are no dental fragments or foreign bodies in the soft tissues, imaging may be considered. Plain X-rays of the facial skeleton (eg orthopantomogram, postero-anterior skull or occipito-mental views) are usually sufficient for the assessment of uncomplicated trauma (eg isolated mandibular fractures). Computed tomography (CT) is required for significant injuries (eg multiple facial injuries, middle third facial injuries, associated head injury).

Presumptive antibiotic therapy may be required for wounds at high risk of infection or significantly contaminated wounds (see Post-traumatic wound infections).

Antibiotic prophylaxis is not required for closed or open facial fractures that do not require surgical management. Facial fractures requiring surgical management may require surgical antibiotic prophylaxis, given within 120 minutes of the procedure (see Surgical prophylaxis for oral maxillofacial surgery); antibiotic prophylaxis between injury and the perioperative period is usually not necessary. For management of open facial fractures, see Open fractures.

Note: Antibiotic prophylaxis is not required for closed or open facial fractures that do not require surgical management.

Refer all patients with significant maxillofacial trauma to a specialist as soon as possible for further review and management.