Maxfacts

It may come as a surprise but there really is no difference between a “fracture” and a broken bone. The big difference comes whether a fracture is displaced (see Figure 1 for a sketch of a displaced fracture) – which means it is out of alignment and needs to be returned to its previous position and held there. This operation is called reduction and fixation.

If the break is exposed to the outside world through the skin, or mucosal lining of the mouth, or the periodontal ligament around teeth then it is called compound and is more likely to become infected. The operation should then be carried out sooner rather than later.

If the break is in multiple pieces it is called “comminuted” and is often more difficult to treat.

In maxillofacial surgery we deal with the relatively simple skull bones and the massively complex facial bones. Conventionally the face is divided into 1/3rds, upper, middle and lower. The lower is the mandible (bottom jaw) which is broken regularly in isolation as a consequence of intoxicated fighting. The mandible supports the airway and loss of this support is the major risk in severe injuries.

The midface is a complex structure of quite fragile bones supported by vertical pillars and prominent cheekbones (called zygomas or “malars” in the trade). Their main purpose is to protect the eyes and fractures can range from quite simple to extremely complex.

The upper third is the frontal bone and its attachments which is really there to protect the brain. Fractures are less common, although fractures of the bones making up the frontal sinus deserve special attention and are a little controversial in terms of treatment.