Definition

The maxillary bone refers to the upper jaw bone, which is crucial for chewing and supports the teeth. A maxillary fracture is a break in the upper jawbone and is considered a medical emergency. Injuries to the upper jaw often involve the teeth and surrounding structures. The fracture's appearance can vary depending on which part of the upper jaw is affected.

Facial bones, including the maxilla, are thinner and more fragile than the skull. In maxillary fractures, breaks may occur along the upper jawbone and the piriform aperture, which forms part of the nose. Fractures can also extend across the face from one cheek to the other.

Although maxillary fractures are less common than mandibular (lower jaw) fractures, they are often caused by motor vehicle accidents and can severely affect facial functions. Prompt treatment is necessary to avoid long-term impairment and disability.

Causes

Maxillary fractures result primarily from trauma or injury, which damages both bone and soft tissue in the face. Various factors can lead to maxillary fractures, including:

• Motor vehicle accidents
• Accidental falls from heights
• Violence or altercations
• Workplace accidents
• Sports injuries
• Firearm injuries

The severity of a maxillary fracture depends on the area of the face affected, the injury's mechanism, the pressure on the upper jaw, and the direction of the impact. The number of cases has been rising due to increased use of road transportation and busier lifestyles.

Risk Factor

The risk factors for maxillary fractures include:

• Male gender
• Frequent use of road vehicles
• Unsafe driving habits, like speeding or failing to use seat belts/helmets
• Post-operative infections in the face
• Contact sports (e.g., football, rugby)
• Alcohol or drug use
• Lack of protective gear in work environments
• Victims of domestic violence

Symptoms

Symptoms of maxillary fractures can include:

• Facial and oral pain
• Swelling, bruising, jaw bleeding, or nosebleeds
• Nerve issues, such as numbness or loss of sensation in the jaw or face
• Altered facial shape
• Difficulty opening the mouth
• Vision problems, such as double vision, limited eye movement, or reduced vision

Diagnosis

The initial examination focuses on determining if the patient's condition is stable or if immediate treatment is necessary (e.g., for airway obstruction or shock). In cases of facial trauma, the doctor will also assess for injuries to the cervical spine or head.

To diagnose maxillary fractures, the doctor will conduct a medical interview, physical examination, and possibly further diagnostic tests.

Medical Interview

The doctor will ask about current symptoms related to the fracture and how the injury occurred (e.g., traffic accident, sports injury, workplace incident). The patient's medical history, especially factors that increase fracture risk, will also be discussed.

Physical Examination

The doctor will check the patient's vital signs to determine stability and assess the following areas:

• Airway
• Face and jaw
• Nerves in the face and jaw
• Mouth and teeth
• Eyes
• Neck and head

Diagnostic Tests

To confirm a maxillary fracture, radiological imaging is used to visualize the bones and soft tissue in the affected area. This can include X-rays, panoramic radiographs, CT scans and MRI.

Management

Treatment for maxillary fractures involves the following steps:

• Ensuring that the airway remains open and unobstructed is a critical first step.
• Bleeding must be managed, and any wounds should be cleaned and closed.
• The fractured bones are realigned and fixed to promote proper healing and recovery.
• Restoring facial structure and function.

Post-treatment, patients should stick to soft or liquid foods and avoid activities like blowing their nose to minimize further injury.

In cases of maxillofacial fractures, a plastic surgeon typically handles the examination and surgical repair, especially based on the fracture's type and severity. Consulting a plastic surgeon is essential as prolonged pain can affect chewing function and alter facial structure if left untreated.

Surgery is mandatory when the fracture affects the eye socket or surrounding structures, especially if bleeding compresses the optic nerve. Other indications for surgery include severe facial disfigurement or complete jaw fractures.

Complications

Complications from maxillary fractures include early-stage issues such as severe bleeding and airway obstruction due to displaced bone fragments and tissue swelling. Although less common than in mandibular fractures, infections can still occur in maxillary wounds.

In rare cases, vision loss can happen due to bleeding affecting the optic nerve. Later complications may include:

• Failure of the bone to heal properly (nonunion)
• Misalignment during healing (malunion)
• Blockage of the tear ducts (lacrimal system)
• Loss of sensation in parts of the face

Prevention

Since traffic accidents are a major cause of maxillary fractures, preventive measures include ensuring that vehicles are in good working order, wearing seat belts or helmets, and obeying speed limits to reduce the severity of trauma.

Personal protective equipment is also crucial in work environments prone to accidents or during contact sports. Being mindful of injury risks is essential for safety.

When to See a Doctor?

Maxillary fractures are emergency conditions requiring immediate medical attention. If you or someone you know experiences this injury, prompt treatment in an emergency room is vital.

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