Oro-maxillofacial and Plastic Surgery

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Knowledge creates healing

Traumatology

In medicine, the word trauma is used to describe damage, injury or wound caused by external force. The treatment of facial injuries is one of the foundation pillars of oro-maxillofacial surgery. The regular, intensive confrontation with this field, for historical reasons due to the two world wars, has predestined our specialist subject to a team of experts. However a differentiation must be made between injuries limited to soft tissue and those where the bone is involved (fractures). Our goal when treating wounds is always to finish with minimal scarring.  

Adequate primary treatment of small and larger injuries is of major importance for perfect aesthetic results. If immediate adequate treatment does not take place, a secondary, far more extensive correction is required. If a facial-cranial fracture is suspected, we have modern diagnostic and/or imaging methods to confirm and/or clarify the diagnosis. The modern section diagram method (computer tomography and nuclear spin tomography) with different fields of application are always available to clarify a suspected treatment indication. Depending on the severity and localisation of the fractures, immediate treatment is advisable, or as in some case – for example in the area round the bony orbita –  delayed treatment, to await reduction of swelling. In the case of extensive bone injuries the fractures must be set, taking  a cosmetically inconspicuous approach, and stabilized with metal plates or platelets until healed.  

In order to achieve best possible cosmetic end results, the so-called skin tension lines are always taken into consideration. It is also often possible to have cicatrices which are invisible from the outside, using an approach through the mouth. For this we use endoscopic procedures. The most common facial-cranial fracture is that of the zygomatic bone (cheekbone), often accompanied by the orbital floor. This exposed face bone is at risk during sport or bicycle accidents. The same thing applies to impact injuries to the chin, which can lead to a variety of lower jaw fractures, often multiple. The reconstruction of the foundation pillars of the facial skull plays a major role in the treatment of extensive, multiple fractures, thus guaranteeing the ensuing stability. This is often only possible after adjustment of the existing, regular bite, also called occlusion. Fractures of the facial skull are nearly always treated with titanium plates, and we advocate their removal after a certain period of time.  

The Klinikum rechts der Isar is a nationwide address for polytraumata (especially severe injuries caused by accidents). The smooth and excellent collaboration with neighbouring specialist departments also involved in the treatment is constantly proving its value: an experienced team is at hand, 24 hours a day, 365 days a year.

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Picture 1: Skull model, with various titanium osteosynthesis plates, which are regularly used for fractures in the facial skull region. 

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Picture 2. This computer tomography image shows a cross-section of the skull, with a displaced fracture of the frontal sinus wall.  

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Picture 3: This post-operative x-ray picture controls the position of the osteosynthesis plates in the forehead, after the correct alignment of the fracture.  

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Picture 4: Double fracture of the lower jaw, with fractures next to the middle of the jaw and on the left (not easy to see) in the angle of the jaw, by the wisdom tooth which has not yet broken through. A molar destroyed by caries is also visible on the right hand part of the lower jaw.

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Picture 5: Situation after osteosynthetic treatment of the fractures, using a linea-obliqua plate on the left, and 2 mini plates on the right. The perfect bite was adjusted and secured using an upper and lower occlusal splint. The wisdom tooth which has not yet broken through on the left of the fracture was left for stability reasons until the metal plates are removed, the carious molar on the right was extracted.