In 30 seconds: Facial fractures — broken jaw, cheekbone, eye socket (orbital) or nasal bones — usually follow a fall, sports impact or road traffic accident. Not every facial injury needs surgery, but many do, and the anatomy involved (nerves, sinuses, eye position, bite alignment) means the assessment itself has to be precise. A CT scan and an examination by a maxillofacial surgeon determine whether the fracture can be observed, needs to be realigned without surgery, or requires plates and screws to rebuild the bone. Getting seen within the first few days matters more than most patients expect, because swelling can hide problems and healing bone becomes harder to reposition after 10–14 days.
Just had a facial injury? Here is what actually needs urgent attention
Most bumps and bruises to the face heal on their own. A small set of signs, though, point to a fracture or a problem serious enough to need a specialist opinion quickly:
- Double vision, or one eye that looks lower/sunken than the other
- Numbness of the cheek, upper lip or teeth on one side
- Your teeth no longer meet the way they used to when you bite down
- Visible flattening or asymmetry of the cheekbone, jaw or nose
- Difficulty opening the mouth fully, or the jaw shifting to one side when you try
- Bleeding from the nose that won’t settle, or a nose that looks visibly crooked
- Persistent swelling that gets worse rather than better after 48 hours
None of these confirm a fracture on their own, but any of them is a reason to be examined rather than to wait and see.
Why the face fractures in predictable patterns
The facial skeleton is not one solid block of bone — it is a set of thinner bones (nasal, orbital floor, cheekbone/zygoma, jaw) connected at fairly consistent weak points. That is why the same type of accident tends to produce the same type of injury:
- Nasal bone fractures — the most common facial fracture, from a direct front or side impact.
- Zygomatic (cheekbone) fractures — from a blow to the side of the face; can flatten the cheek and affect the nerve that supplies sensation to that side.
- Orbital fractures — the thin bone under or beside the eye gives way before the eyeball itself is damaged, which is why double vision or a sunken eye needs same-week assessment.
- Mandible (jaw) fractures — often break in two places at once because of how the jawbone is shaped, which is why the bite is such a reliable clue.
- Midface (Le Fort) fractures — higher-energy injuries (road traffic accidents, sports collisions) where several bones move together; these need the most careful surgical planning.
How a facial fracture is actually diagnosed
A visual exam and gentle palpation of the facial bones is the starting point, but bone displacement, sinus involvement and the position of the eye or teeth cannot be judged accurately by eye alone. A CT scan (not a plain X-ray) is the standard for anything beyond a straightforward nasal injury, because it shows the fracture in three dimensions — which matters for planning whether it needs fixation and, if so, exactly where the plates need to go. Vision is checked, sensation is mapped on both sides of the face, and the bite is examined with the patient’s own memory of “how my teeth used to meet” as the reference point.
| Fracture type | Typical sign | Usual next step |
|---|---|---|
| Nasal bone | Visible crookedness, nosebleed | Wait for swelling to settle, then reassess alignment |
| Zygoma (cheekbone) | Flattened cheek, cheek numbness | CT scan; surgery if displaced |
| Orbital floor | Double vision, sunken eye | CT scan urgently; ophthalmology + maxillofacial review |
| Mandible (jaw) | Bite feels “off,” limited opening | CT scan; fixation is common |
| Midface (Le Fort) | Facial elongation, midface mobility | CT scan; staged surgical planning |
Why this is a maxillofacial surgeon’s territory, not a general emergency fix
A fractured arm or leg has one job: hold weight and bend at a joint. The facial skeleton has to do several jobs in a very small, densely packed space — protect the eye, carry the nerves that give sensation to the cheek and lip, house the sinuses, and hold teeth in a bite that has to line up to within a millimetre or two for normal chewing and speech. Realigning these bones without disturbing the nerve running through the jaw, or without narrowing the space around the eye, is not a generalist procedure. It is why facial trauma is managed by maxillofacial surgeons specifically — surgeons trained in both the bone anatomy and the dental occlusion, so that fixing the fracture does not leave the bite permanently altered. Even injuries that look “simple” on a scan, like a single cheekbone fracture, sit directly against the nerve that supplies the cheek and upper lip; plating it safely depends on knowing exactly where that nerve runs.
Treatment options: what actually happens next
- Observation — many undisplaced or minor fractures (a hairline crack in the nasal bone, for example) heal without intervention. Follow-up imaging confirms the bone is settling correctly.
- Closed reduction — the bone is realigned manually or under a brief anaesthetic without an open incision. Common for straightforward nasal fractures seen early, before the bone starts to set.
- Open reduction and internal fixation (ORIF) — for displaced cheekbone, jaw or midface fractures, small titanium plates and screws hold the bone in the correct position while it heals, usually placed through incisions hidden inside the mouth or in natural skin creases.
- Staged or combined care — orbital and midface injuries are often managed jointly with ophthalmology or ENT when the eye or sinuses are involved.
Local or general anaesthesia is used depending on the fracture and the fixation needed; the choice is made case by case at consultation.
The approach used at the practice
Assessment starts with a full facial and neurological exam alongside a CT scan, so decisions are based on the actual three-dimensional injury rather than a visual impression. Where the fracture affects the bite, the mandible or the midface, treatment planning draws on the same orthognathic and jaw-surgery experience used for elective double-jaw cases — the goal being a bite and facial symmetry that match what the patient had before the injury, not just “bone healed.” Timing is explained clearly: some fractures benefit from a short window to let swelling settle before surgery, others need fixation sooner rather than later, and that distinction is made at the first visit, not left open-ended.
Frequently asked questions
Do all facial fractures need surgery?
No. Many undisplaced fractures, particularly of the nasal bones, heal with observation alone. The CT scan and clinical exam determine whether the bone is stable enough to leave alone or displaced enough to need fixation.
How soon after an injury should I be seen?
As soon as possible, ideally within a few days. Swelling can mask a fracture in the first 24–48 hours, and bone that has started to heal in a displaced position becomes progressively harder to realign after roughly 10–14 days.
Will a plate or screw be visible or felt afterward?
Titanium plates used in facial fracture fixation are small and placed either through incisions hidden inside the mouth or along natural skin creases. They are not usually visible, and most patients do not feel them once healing is complete.
Can a broken jaw change my bite permanently?
It can, if it heals in the wrong position. This is exactly why bite alignment is checked and re-checked throughout treatment — the objective is to restore the pre-injury bite, not just to reunite the bone.
Is a black eye after facial trauma always serious?
Not always, but any bruising around the eye combined with double vision, a change in eye position, or reduced eye movement needs urgent evaluation to rule out an orbital fracture.
Do I need a dentist or a maxillofacial surgeon for a jaw fracture?
A maxillofacial surgeon. Jaw fractures involve bone repositioning, nerve protection and bite reconstruction together — the same combined skill set used in elective jaw surgery, applied under trauma conditions.
Will there be a visible scar?
Where possible, incisions are placed inside the mouth or along natural skin folds specifically to minimise visible scarring. This is discussed as part of surgical planning for each fracture pattern.
About the author
Dr Marc-Kevin Le Roux is a French board-certified maxillofacial surgeon practising in Dubai, with a clinical focus spanning orthognathic (jaw) surgery, facial trauma reconstruction, and facial aesthetic surgery. His training combines dental occlusion expertise with craniofacial surgical technique — the same combination that facial fracture repair depends on. Learn more on his About page.
If you have had a recent facial injury and are concerned about a possible fracture, an evaluation with imaging and a full facial exam is the safest next step. → Book your consultation
Related: Double Jaw Surgery · TMJ and Jaw Clenching: When to See a Maxillofacial Surgeon · Orthognathic Surgery Recovery
