Facial Trauma can result in open wounds, broken bones, scars, or facial asymmetry. Reconstruction requires meticulous repair of all injured structures by an experienced surgeon. Dr. Taylor and Dr. Sullivan are both fellowship trained in Craniomaxillofacial Surgery and are former co-directors of the Division of Craniofacial Surgery at Brown University. Because of their experience, they have been named faculty members for AOCMF to teach other surgeons the principles of proper facial fracture repair and reconstruction. They have published extensively on their experience in helping patients with traumatic or acquired facial injuries and have educated colleagues nationally and internationally. If you have a new facial injury or a past history of an injury with ongoing problems, please contact us for an evaluation and carefully planned approach to restore your face. Most operations related to facial trauma are covered by insurance.
Facial Trauma and Facial Bone Fractures
We enjoy looking after patients with a broad range of problems in our practice. We particularly enjoy restoring facial form and function after trauma. With many years of working at high volume trauma centers, we feel very comfortable performing complex reconstructions of bony and soft tissue injuries of the face and head, taking advantage of the latest technologies. These include nasal, mandibular, maxillary, orbital and frontal bone fractures. We hope you wear your helmet and never need our services. But if you do, we will do our best to put things back where they belong.
When indicated, we will use the latest technology to rebuild facial structures, including 3D imaging, 3D presurgical planning, and 3D printing. Most facial fractures are repaired with mini or microplates and screws made of titanium. Some doctors may shave a patients hair or us extensive incisions. Dr. Taylor and Dr. Sullivan are experienced facial and craniomaxiofacial surgeons in the Boston Mass area who will conceal incisions inside the mouth or eyelid creases and don’t usually need to shave any hair for even the most complicated facial reconstruction operations.
Open Reduction and Internal Fixation of Facial Fractures
Not all facial fractures require surgery. But when the bones are significantly displaced and/or mobile, we will often recommend open reduction and internal fixation. We expose the fractures through well concealed incisions, put the bones back in their correct position, and secure them with titanium microplates and screws.
While the risks include residual asymmetry, infection, damage to facial nerves, and need for hardware removal, these complications are thankfully rare. Our goal is to restore things to their pre-injury state with the lowest risk to the patient. Dr. Taylor and Dr. Sullivan conduct research, publish their experience with facial fracture treatment, and use the latest technology to reconstruct the face, including 3D planning, 3D printing, and titanium miniplate fixation (above images show plating in red following repair of extensive pan- or complete facial fractures.
Repair of Zygomatic Complex (ZMC or “Tripod”) fractures
This is an example of a 3D CT scan demonstrating a right zygomaticomaxillary complex (ZMC) or “tripod" fracture. On the left the image demonstrates the severe inferior position of the ZMC due to the downward pull of the masseter muscle. Over time, the patient became severely disfigured. Dr. Taylor and Dr. Sullivan used the latest technology to reconstruct the face, including 3D planning, 3D printing, intraoperative CT scan and intraoperative image guidance. The center image demonstrates the goals with this technology. On the right, the facial bones have been reconstructed and repaired with titanium miniplates for rigid internal fixation. Incisions are hidden inside the mouth and in a wrinkle in the upper eyelid and lower eyelid. Their novel use of this technology was published: Morrison CS, Taylor HO, Sullivan SR. Utilization of intraoperative 3D navigation for delayed reconstruction of orbitozygomatic complex fractures. Journal of Craniofacial Surgery. 2013;24(3):e284-286.
Cranial and Facial Implants
Restoring normal appearance of skull and facial profile while protecting the brain, eyes or critical structures is of primary importance when repairing facial fractures. Dr. Taylor and Dr. Sullivan use technology such as 3D preoperative planning and 3D printing to customize treatment plans for patients with cranial or facial deformities because of previous operations, trauma, cancer or congenital anomalies such as craniosynostosis.
Cranioplasty with 3D planning and 3D printing of Cranial and Facial Implants
Patient with extensive facial fractures and skull defect who underwent reconstruction and cranioplasty following careful 3D planning and 3D printing of a custom cranial and facial implant with Dr. Sullivan and Dr. Taylor.
Tooth Implants and Occlusion Reconstruction
Restoring alignment of teeth is one of the primary goals with repair of facial fractures. Dr. Taylor and Dr. Sullivan are both fellowship trained craniomaxillofacial surgeons and board certified plastic surgeons who are experienced with complex facial reconstruction.
Restored Occlusion and Teeth
This patient had extensive facial fractures and avlused teeth. Following open reduction and internal fixation of facial fractures, the teeth lined up well though lower teeth were missing from the injury (upper photo). Dr. Taylor and Dr. Sullivan worked closely with a dentist to have a prosthesis built (upper right photo). The teeth and prosthesis are well lined up following proper facial fracture repair (lower row photos).
Recommendations for Antibiotics for Facial Fractures
Post-injury prophylactic antibiotics likely provide no benefit in maxillary, zygomatic, or mandibular condyle fractures. Closed isolated anterior table frontal sinus fractures and orbital fractures also rarely become infected and likely do not require antibiotics. Some fractures, for example mandibular body and angle fractures, particularly those that penetrate a tooth root can have infection rates up to 30%. Frontal sinus fractures with disruption of the frontonasal duct may have a 16% infection rate even after surgical treatment. A short course of antibiotics in conjunction with chlorhexidine mouth rinses may be warranted in such fractures.
In terms of perioperative antibiotics, it seems reasonable to give a first generation cephalosporin for no more than 24 hours for low risk, closed facial fracture repairs. Ballistic injuries, grossly contaminated open facial fractures, nasal fractures with packing in place, and infected mandibular fractures may require a 4-5 day postoperative course of antibiotics.