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Facial Bone Fractures New York City

Dr. Sherman is a recognized expert in facial trauma, and has been teaching repair and treatment at New York Presbyterian Hospital for over 30 years. He is a member of The American Society of Maxillofacial Surgeons and is a co-author of a recognized textbook for the treatment of these injuries. Patients come to him from all over the country and around the world to help reconstruct their facial bones after fractures. Dr. Sherman works with a multi specialty team to address all the issues and tissues involved within a simple or complex facial fracture: maxilla, mid face and fracturing of the orbits.

25 year old male who fell from second story window, sustaining Le Fort III multiple facial fractures of the maxilla, mandible, midface and both orbits. Dr. John Sherman led his multispecialty team in reestablishing normal facial anatomy. Reduction and occlusion were restored after the fixation with multiple screws and plates (blue)
25 year old male who fell from second story window, sustaining Le Fort III multiple facial fractures of the maxilla, mandible, midface and both orbits. Dr. John Sherman led his multispecialty team in reestablishing normal facial anatomy. Reduction and occlusion were restored after the fixation with multiple screws and plates (blue)

Nasal Fractures (Broken Nose)

The most commonly injured bone of the facial skeleton is the nasal bone. This occurs as a result of blunt trauma, auto accident, and sports injuries. Initially, the patient may only notice swelling, a bloody nose, and pain. With swelling present, the actual fracture may easily be overlooked by the emergency room physician.

Depressed fracture of nasal bone. (Illus. from Surgery of Facial Bone Fractures by John E. Sherman MD)
Depressed fracture of nasal bone. (Illus. from Surgery of Facial Bone Fractures by John E. Sherman MD)

 

Treatment of Nasal Fractures

Treatment is relatively easy, and must be performed on a timely basis. These fractures are rarely treated acutely because of the swelling that is present. Dr. Sherman usually prefers to do these after four days when the swelling has subsided, and before two weeks at which time the fracture is healed. In this interval of time, a closed reduction of the fracture may be performed either on local anesthesia or with sedation by a board-certified anesthesiologist.

A Closed Reduction can be performed in the office setting, or as an out-patient at the hospital. If the reduction is necessary after the 2 to 3 week interval the patient must wait two months for swelling and the nasal bones to heal. At that time, and open reduction of the nasal fracture is performed, which is usually more involved than the simple closed reduction.

After the treatment of nasal fracture, the patient wears a splint for about 6 to 7 days. After two days swelling is modest, and the patient usually can return to work. You should be aware that the nasal bones can move until fully set which takes about three weeks.

Even after the reduction of the nasal fracture, the patient may have difficulty breathing months later because of changes to the septal cartilage (septum). At that time, this may also be corrected with a septoplasty.

 

Orbital Fractures

An orbital fracture is a traumatic injury to the bones of the eye socket – either the thicker, bony outer rim, the very thin orbital floor beneath the eye, or both. These fractures are generally caused by blunt force, such as a car accident or sports injury, and can impede natural eye movement and functioning.

 

Symptoms of Orbital Fractures:

  • Bruising around the eyes
  • Double Vision
  • Numbness around the eye socket
  • Decreased ability to move eye normally

Image of 59 year old patient with orbital fracture showing titanium plate in reconstruction of the orbital floor.
Image of 59 year old patient with orbital fracture showing titanium plate in reconstruction of the orbital floor.

 

Facial Fractures and Cheekbone Surgery

Facial fractures (broken facial bones) are fractures of the facial skeleton. They most commonly occur to the nasal bones, orbit and cheek as a result of blunt object impact, car accidents or other injuries. Initial bruising can inhibit any definite signs that a broken cheek is present. Depending on how severe the trauma, some patients won’t notice the small fracture until the pain begins or some deformation of the cheek shows after swelling goes down.

Fracture of the left cheekbone (zygoma). (Illus. from Surgery of Facial Bone Fractures by John E. Sherman MD)
Fracture of the left cheekbone (zygoma). (Illus. from Surgery of Facial Bone Fractures by John E. Sherman MD)

 

Facial Anatomy of the Cheekbones

The cheekbones are bones that involve the area around the orbit of the eye (beneath and around the eye socket), the zygoma, zygomatic arch, and the maxilla. The zygomatic arch is the bone area that connects the under-bone of the eye to the area below the temple just before (anterior to) the ear. A tripod fracture is a facial fracture that involves the zygoma which is displaced. It may involve the arch and the orbit.

 

How to Know if You Have a Cheek Fracture

Cheekbone fractures often are painful if they are displaced. Often the individual that has the cheekbone fracture will find that chewing, talking, yawning or anything having to do with the movement of the face in that area, will be painful. The additional fracture pain is due to the compression of the zygoma (cheekbone area) on the muscles that are below which help you chew.

The area of the cheek extending to the teeth of the maxilla (upper jaw) may also be numb. This is due to the injury to the infraorbital nerve which is often involved at the fracture site. Sensation usually returns up to nine months later.

Diagnosis of these injures is made after a CT scan. If you have an orbital injury, an ophthalmologist should also examine the eye to make sure that there is no damage to the globe.

 

Symptoms of Facial Fractures:

  • Swelling of the cheek area
  • Bruising
  • Pain, eating, chewing or talking
  • Uneven meeting of the teeth
  • Vision problems
  • Flattening of cheek
  • Loss of feeling in the cheek area or under the eye

Should you experience any of these symptoms after any trauma to the face such as a car accident, sports or hiking related injury, consult a facial trauma specialist that works with facial fractures such as broken cheekbones for the best treatment and results.

 

Treatment of Fractures

The patient must be evaluated to ensure that no other injuries are present. Orthopedic surgeons, critical care physicians, and neurosurgeons are often involved in the treatment of the more complex injuries.

Surgery is usually performed after hospital admission and may require several days stay at the hospital. Remarkably, after the fractures are stabilized, pain is modest and the patient feels better because there is no more movement of the involved bones.

Access incisions may be made in the mouth, eyelid (transconjunctival) and the brow. More complex fractures may involve incisions behind the hairline.

 

Benefits of Surgery:

  • Pain relief
  • Shape and structure of cheekbone remedied
  • Improves vision issues

If you’ve suffered from a cheek fracture, facial trauma, or have previous facial injury, contact the office to schedule your consultation with Dr. Sherman, a world renowned facial trauma specialist, today. If you are hospitalized, transfer to the New York Presbyterian hospital can be arranged.

Schedule Your Consultation Today

If you would like to meet with Dr. John Sherman to discuss your options, please contact our practice today. Dr. Sherman will be happy to answer your questions and
talk with you about procedures that may be right for you.

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New York plastic surgeon John E. Sherman, MD, FACS offers breast augmentation, breast reduction, facelift, nose surgery (rhinoplasty), ear surgery (otoplasty), tummy tuck (abdominoplasty), and a wide range of other plastic surgery procedures and cosmetic treatments. Dr. Sherman treats patients in the New York area. Patients from other areas of the U.S. and throughout the world travel to New York for plastic surgery with Dr. Sherman. Photos of actual plastic surgery patients are available in the plastic surgery before and after photo gallery. Dr. Sherman is a top NY Breast Augmentation doctor on RealSelf.