Facial Reconstruction and Facial (maxillofacial) Trauma Surgery

When dealing with facial injuries in the workplace, or following a car accident, a fall, or even by inter-personal violence… oral & maxillofacial surgeons are the key specialist surgical group to seek referral to for your facial reconstruction and rehabilitation needs.

For facial injuries that do not also involve head injuries or neck injuries or more systemic injury, you can be directly referred to an oral & maxillofacial surgeon by your medical GP, your family dentist, or even your work place occupational health and safety or OHS officer through WorkCover (also known as Work Cover or Work Safe).

Where facial injury is more severe or if it is associated with wider injury such as head injury or neck injury, then usually your first line of treatment will be in a public hospital, by public surgeons.

Facial injury surgery is not performed by cosmetic surgeons. Occasionally your Plastic Surgeon, Ear, Nose and Throat Surgeon, or General Surgeon will have some limited training in Maxillofacial Surgery. But most people will be treated by surgeons who are specifically registered and therefore specifically trained as Oral & Maxillofacial Surgeons.

Hopefully this website has been a guide for you.

How do I get referred to an Oral & Maxillofacial surgeon for my facial injury?

If your injury was at work, then your occupational health and safety OH&S advisor can liaise with your medical GP, usually providing a direct referral to your oral and maxillofacial surgeon.

For inter-personal or motor vehicle accident (MVA) related injuries, then your acute management can be through a public hospital, or to wherever the ambulance takes you. Public hospitals rarely manage long term rehabilitation issues, or even complex, ambulatory based reconstruction (especially involving dental implants, or facial fracture or facial scarring resection). If you do not have a head injury, and you have private hospital insurance, you should ask for a private referral to a private specialist and a private hospital, where your stay can be more comfortable, your treatment is prioritized, and where you can expect a private room.

Most often, facial injury also affects your teeth or your dental bite. Not knowing where to turn, and in times of crisis, it is often appropriate to seek advice from your family dental surgeon (general dentist), who is more than likely to also refer you to an oral & maxillofacial surgeon.

What should I expect from treatment of my facial injuries?

Your private surgeon is also there to help you for the long term, and can coordinate your long-term multi-disciplinary therapies with other co-practitioners, such as private dentists, physiotherapists, orthodontists, or other surgical practitioners.

Oral & Maxillofacial surgeons are generally regarded as the first line of treatment for all facial injuries. But ongoing rehabilitation from facial injury is often a multi-practitioner event.

Generally, maxillofacial surgeons are experts when it comes to the hard tissues of your face. Re-aligning a crooked nose, elevating a depressed cheek bone, fixing an eye socket fracture (also called an orbital blow out), repairing skin and lip lacerations and cuts, and putting your fractured jaws together into realignment is also part and parcel of what acute oral and maxillofacial surgeons do.

But after you have healed, and after the acute crisis of often life saving surgery has passed, who picks up the pieces, and who puts your face and smile back to where you had them before your accident took place?

Your oral & maxillofacial surgeon is an expert of the hard tissues of your face. As surgeons, they are trained in bone grafting, and osteotomy procedures which aim to realign your face into the proper proportions and positions that your face should normally have been. Oral & Maxillofacial Surgeons work with orthodontists to help re-align your teeth, and give you back a normal bite. They also work with dentists to replace fractured or missing teeth through dental implants. They can work with ophthalmologists to realign your vision and the position of your eyes and eye sockets. And they work with Plastic or ENT Surgeons, who in turn can reposition the soft portions of your face, such as your nasal tip through rhinoplasty or nose jobs, nasal septum through septoplasty, or resection of unsightly scars.

Remember, maxillofacial surgeons are usually not also cosmetic surgeons. Plastic surgery procedures like rhinoplasty (nose job), face lift (facelift), blepharoplasty, and liposuction are usually in the same conversation as talking about Botox, a total makeover, a breast implant, breast enlargement, breast enhancement and tummy tucks or abdominoplasty. Maxillofacial surgeons are there to provide reconstructive surgery to your face, and to your jaws, and to your facial bones. Whilst these procedures are considered to obviously make you look better, and not worse, they are still not seen to be cosmetic surgery.

What insurance rebates are there for treatment of my facial injury?

In NSW, victims of violence across the state (including Newcastle and Sydney) can access rebates to help cover the costs of their treatment through the NSW Victims Compensation Scheme. Work place injury is covered by NSW WorkCover or WorkSafe workers compensation insurance schemes held by your employer. Prior to any treatment, your surgeon must first gain approval from the insurer, and this can take some days to weeks to gain. Likewise, if your injury was from a motor vehicle accident, then compulsory third party insurance is available to cover for the costs of your treatment, as well as for compensation related to permanent disability should you also require this. You should consult with a compensation lawyer, or legal offices that specializes in public and insurance based injury compensation schemes, and seek specialized legal advice directed to people who have generally suffered any form of injury.

Most people however will have injuries that did not occur because of work, violence or from a car accident. For major facial injuries, the public hospital system is always available for acute forms of treatment and care, but longer term care is usually up to you to look for and coordinate. In such cases, corrective rehabilitation or reconstruction procedures can be costly without the assistance of private medical or hospital insurance.

For the milder forms of injury, particularly if you are ambulant and without other injuries, then seeking care by a private surgical specialist should be your first line of enquiry. You can expect to present to a Medical GP or dental surgery or even an orthodontist for a referral. Medicare offers rebates for all x-rays and consultations provided by registered private maxillofacial surgeons in Australia.

What should I expect from my examination when I see an oral & maxillofacial surgeon for my facial injury?

Whilst any form of facial injury can obviously affect the outer layer of your skin, meaning your skin, lips, nose or front teeth… maxillofacial surgeons are primarily concerned with what lies beneath… or with examining for and detecting injuries that have occurred in the deeper tissues of your face.

Hitting your chin, can produce a laceration on the underside of your jaw… but it can also cause primary damage to your TMJ, or temporomandibular jaw joints. Hitting your upper teeth can fracture or loosen them, but your other teeth may also have fractures or even fine cracks, and these also must be looked for. Hitting your eye socket directly with a tennis ball, can cause double vision, but no discernable injury. But on x-ray examination there may be an orbital floor blow out fracture affecting your eye-socket, and without detection and treatment, this can lead to irreversible visual damage.

Like a shattered windscreen, major cracks can be obvious, but there can also be numerous finer cracks, all of which have to be detected and often primarily repaired, in order to achieve normal facial proportions, and of course restore your bite and your face to what you were before your accident. Sometimes rebuilding your face is as complex as rebuilding the shell of a broken egg.

Your first visit is always going to begin with a thorough examination by your surgeon. He or she will check your eyes, your bite, your skin and your facial bones as well as teeth. The surgeon will often use radiology tools, in the form of x-rays, and the best modalities for this are first through OPG (Orthopantomogram), and then using CT (computerized tomography), or even ConeBeam. The most advanced of practices will have manipulative software to convert your CT or ConeBeam data into 3 dimensional visual worlds, highlighting your facial skeleton, and also how and in what direction to pull back your broken face into realignment.

At the time of your visit, your surgeon will assist you in interpreting your insurance status, and in arranging for a hospital stay, and also theatre preparation for the correction of your facial injuries. Your oral & maxillofacial surgeon can then plan consequent rehabilitation procedures, to maximize the opportunities for you to be completely, and hopefully perfectly restored to your pre-injury facial and dental state.

Who would be involved in my facial surgery and my subsequent rehabilitation?

There are a surprising number of people who will become involved in your facial injury management. Of course your medical GP will be a major factor in making sure you are generally and also mentally well. But it will be your oral & maxillofacial surgeon who will come to coordinate all the different facets of your acute facial injury, and post-injury care.

Your oral & maxillofacial surgeon will often times work with your general dentist (or family dental surgeon), to make sure that you do not have any fractured teeth. If you have fractured your teeth, most often they will need to be assessed for salvageability by filling or crown repair, or even root canal therapy. Often though, there are many fine cracks in teeth that may not be evident at first glance, so long term review of your teeth is essential, and occasionally also you may also lose those that are not treatable by dentistry alone.

Dental implants are an excellent way to replace lost or missing teeth, and you should look at surgery that combines simultaneous removal of fractured teeth with immediate implant replacement. This is rarely performed in public hospital settings, so if you have lost teeth during the immediate trauma management process, then later on, surgical rehabilitation will aim to replace these lost teeth and tissue through various surgical techniques. These are also coordinated between your oral and maxillofacial surgeon and family dentist.

Sometimes, despite the best of care, the repair and reconstruction of your face, will lead to a persisting malocclusion, or a sense that your bite is still not quite right. In these cases your oral & maxillofacial surgeon will coordinate rehabilitation terhapy with your orthodontist. By using braces, and occasional jaw corrections surgery techniques, your bite can be made not only the way it was, but often times even better than what it was.

If you are left with significant skin scarring, there are many plastic and cosmetic surgical techniques that are available for your care. Some oral & maxillofacial surgeons do practice cosmetic surgery, but most do not; so do not be surprised if they refer you to another cosmetic surgeon for laser skin recontouring, chemical skin peels, or even formal scar resection.

If you have persisting visual issues, your surgeon will coordinate care with your ophthalmologist. If you have residual nasal breathing difficulties, your ENT surgeon (otolaryngologist) may also be recruited to assist with helping to clear your nasal passages usually through nasal revision surgery (rhinoplasty or naso-septoplasty).

Of course there are lots of other people who are also involved. You may have a case worker from your insurance company who is approving and monitoring the various medical and dental treatments that you are having. There are often also lawyers who may be assisting you in gaining compensation for your injuries, not just to cover your medical expenses, but also your economic costs of being away from work, or from generally being disabled. There are physiotherapists, occupational therapists, radiologists, radiographers, nursing staff, and a raft of other practitioners from all walks of life that will come to assist you.

How do I find a surgeon to help me with my facial injuries?

First off, find someone local. University and public institutions can offer free treatment, but they don’t offer necessarily the best treatment suited to both your short term and long term needs. There is no greater confidence you can gain, than by being referred by someone whom you already trust. Seek the advice of your GP or family dentist when it comes to assessing your facial injury in the first place, or in seeking how to progress away from your acute management into rehabilitation and rehabilitative facial reconstruction.

Seeking your own care is hard to do if you are unconscious, and being pulled off an ambulance into an emergency ward, and being treated by someone you have never heard of and likely will never meet again. You should have confidence that the surgeon who treated you to save your life was doing the best he could under trying circumstances.

But after the acute management, and after you have regained the ability to reason and judge and take control of your own decisions, take the time to look and listen, and seek the best rehabilitation and reconstruction care you can.