Many facial fractures heal well without an operation, particularly undisplaced cracks in the nose, cheek or jaw where the bones have stayed in position. Surgery becomes necessary when the broken pieces have moved enough to change how you see, bite, breathe or look, or when a bone is pressing on something it should not. The signs below are the ones that most reliably point towards an operation. If you have any of them after a fall, an assault, a road accident or a sporting injury, get assessed quickly rather than waiting for the swelling to settle. Facial bones begin to knit within a couple of weeks, and correcting them is far easier before that happens.
Is your bite suddenly different?
This is the single most useful sign, and you can check it yourself. Close your teeth gently together. If the teeth do not meet the way they always did, if only the back teeth touch, if the jaw slides to one side, or if you cannot bring your teeth together at all, the jaw or the upper facial bones have almost certainly shifted. Doctors call this a change in occlusion, and it does not correct itself. A jaw that heals in the wrong position causes lasting problems with chewing and often with jaw joint pain, so this finding usually means surgery to reposition and fix the bone.
Are you seeing double?
Double vision after a blow to the eye socket is a warning sign that must not be ignored. It can mean that the thin floor of the orbit has broken and that muscle or fat has dropped into the sinus below, tethering the eye so it cannot move in step with the other one. Other eye related signs that need urgent attention include an eye that looks sunken or set back, an eye that sits at a different level from the other, pain when looking up or down, and any loss of vision, flashes or a curtain across the sight. Sudden loss of vision after facial injury is an emergency, so go to an emergency department immediately rather than waiting.
Has part of your face gone numb?
Numbness or a strange tingling over the cheek, the side of the nose, the upper lip and upper teeth suggests the nerve running through the floor of the eye socket has been bruised or trapped by a fracture. Numbness of the lower lip and chin points to the jaw. This is not simply a bruise. It tells the surgeon where the fracture is and how much the bone has moved, and when a displaced fragment is compressing the nerve, freeing and fixing the bone gives the nerve its best chance to recover. Numbness that persists beyond the first days should always be reported.
Does your face look different once the swelling settles?
Swelling hides a great deal in the first few days. As it recedes, look carefully in a mirror and compare the two sides. A cheekbone that has flattened, a face that looks wider, a nose that has bent or collapsed, an eye that looks smaller or deeper, or a step you can feel along the bony rim under the eye all suggest that bone has been displaced. These changes do not improve on their own once healing begins. Photographs taken before the injury are genuinely helpful here, so take them with you to the consultation. Run a fingertip along the rim beneath each eye and along the lower border of the jaw, comparing the two sides as you go, since a step in the bone is often easier to feel than to see once bruising has spread across the area.
Can you open your mouth properly?
Difficulty opening the mouth, pain in front of the ear when chewing, or a jaw that catches or deviates as it opens can all follow a facial fracture. Sometimes a displaced cheekbone physically blocks the movement of the jaw. Other signs from this group include bleeding from the gums with a mobile segment of teeth, a gap that has appeared between teeth, teeth that feel loose, or a change in the way you speak. Any of these deserve prompt assessment, because dental and jaw alignment is difficult to correct later.
Which signs mean you should go to an emergency department right now?
- Any loss of vision, double vision that is worsening, or severe pain in the eye.
- Clear fluid dripping from the nose or ear after a head injury.
- Difficulty breathing, or bleeding you cannot control.
- Drowsiness, vomiting, confusion or a fit after the injury.
- An open wound with bone visible, or a heavily contaminated wound.
These are situations where the injury may extend beyond the facial bones, and they need immediate hospital assessment rather than a clinic appointment.
How will the fracture be confirmed?
Examination comes first, including your bite, eye movements, sensation over the face, and any steps you can feel along the bony edges. A plain X ray has a limited role in the face, so a computed tomography scan is usually the investigation that settles the question, showing exactly which bones are broken and how far they have moved. Where the eye is involved, an ophthalmologist may assess vision and eye movements as well. The plan comes from putting all of this together with what matters to you, such as chewing, vision, breathing and appearance.
Why does timing matter so much?
Facial bones start to unite quite quickly. Operating while the fragments are still mobile allows them to be moved back accurately and held with small plates and screws. Once the fracture has begun to set in a displaced position, correcting it means cutting the bone again, and the result is generally harder to achieve. This is why surgeons prefer to see facial injuries within days rather than weeks. At Elegance Clinic in Surat, Dr. Ashutosh Shah is a Plastic, Reconstructive and Cosmetic Surgeon with more than 22 years of surgical experience who manages facial trauma alongside the rest of his reconstructive practice. If you are unsure whether your injury needs an operation, that question is worth answering early.
