Direct trauma to the face can be caused due to a number of reasons. In India, the number of high impact accidents which cause trauma to the face and eyes is increasing at an alarming rate. The lack of consciousness about following the safety protocol is one of the top reasons why trauma injuries are so common in India. Apart from automobile accidents, occupational injuries also are one of the top causes of trauma injuries in India. Add to these cases, the number of trauma injuries sustained by people during sports and the cases of assaults, and you have an idea India why India is one few top countries having maximum number of trauma cases.
Most of the cases mentioned above can cause blunt trauma to the face which causes very complicated multiple fractures to the face. Trauma to the face and the orbital area can also be fatal because in many cases due to delay in surgery the airway of the patient gets blocked. Apart from the eyes, the tear duct and the eyeballs may also sustain damage which may lead to the eyes losing their function.
Facial fractures are very complex fractures which happen due to trauma to the face. The management of facial fractures is a job which requires great precision and proficiency. Trauma to the face causes injuries to the soft tissues and breakage of facial bones also. Most commonly in cases of blunt facial trauma, the lower jaw or the mandible, nasal bones and maxilla get broken. In very high intensity trauma, the forehead bone or the frontal bone may get ruptured increasing the possibility of injury to the brain. Bruises, cuts, burns etc inevitably are present along with facial fractures. Typically, facial fractures are categorized according to the location of the fractures as Le Fort I, Le Fort II and Le Fort III fractures. In Le Fort I fractures, the palate and the maxilla get separated. The Le Fort II fractures involve the orbital rim and nasal bones. The most difficult to handle facial injuries are caused by Le Fort III fractures which extend and encompass various bones including the ethmoid bone, the maxilla, the lacrimal bone and the orbital floor.
For all Le fort fractures or ZMC fractures, the standard modus operandi is an ORIF which is Open Reduction and Internal Fixation. An ORIF surgery can be simply understood to have two parts; reduction of the broken bone and the internal fixation to ensure that the bones do not get displaced during the healing. The word ’reduction’ refers to restoration of the alignment of the bones. So that the facial bones which have been fractured heal normally, they are fixed with the help of devices so that they do not move. Though the basic premise of all ORIF surgeries is the same, depending upon the type of fracture different approaches may be used to tackle an individual’s case.
Reduction surgery can be of two types; open and closed. In Open Reduction surgery, the surgeon makes an incision on the surface thereby surgically exposing the tissues and the bones. For internal fixation of the broken bones various types of facial implants, screws, rods or plates are used which may be fixed permanently or removed post-operatively.
In most cases of trauma, surgery is the best treatment for the management of the injuries caused by the trauma. The approach for the surgery is decided as according to the cause of the trauma. In most blunt trauma cases, the canalicular area gets damaged. Sometimes, it may be difficult to assess the extent of the trauma and for this the patient may be sedated. Multiple injuries may be caused to the lacrimal system as well which definitely require surgery. Before the trauma surgery is performed, all the wounds are cleaned and any foreign debris is removed from the wound.
Since the skin of the eyelids is also very delicate, most trauma injuries cause cuts and lacerations on the eyelids which are repaired mostly by surgery. Sometimes, because of severe trauma and high impact, our eyes could suffer from multiple cuts and lacerations. Conjunctival lacerations are quite common. Because of the trauma, blood and fluid may accumulate in the eyes. And the most common consequence of trauma is fractures of the orbit which require orbital surgery. Because of trauma to the face, the ocular muscles and nerves get damaged badly. Sometimes, even minor damage to the eye structure after a trauma can prove to be quite complicated in the long run. If the eye muscles are damaged by trauma, there are very high chances of ptosis after sometime.
Orbital fractures are a consequence of trauma with chances of multiple fractures of the orbit being very high. The surgery for orbital trauma is performed according to the nature of the injury. The orbital rim is made up of thick bones which can only be fractured by very high intensity impact. Blowout fractures are also very common because of trauma. Discoloration of the eyes, puffiness of the eyelids and cheeks, loss of sensation in the cheeks etc. are some common symptoms of trauma.
Not every injury requires surgery. The decision about the surgery will depend upon the type of injury. Sometimes topical medication and antibiotics may be enough.
According some of the best studies conducted till now about trauma surgery in India shows that India is inadequately equipped with the top facilities for the trauma surgery. All over India, various trauma centers are available but most of them are not equipped enough to handle large scale trauma. Also, after the primary surgery for trauma most cases require a secondary reconstructive surgery. Barring big cities like Mumbai most trauma centers cannot perform reconstructive surgery because they do not have the best specialists to do the surgery. According to Dr. Shome who practices in Mumbai, barring Mumbai most cities either do not have a trauma surgery center or else they are not capable of handling reconstructive surgery. Many cases come to Dr. Shome after a delay which makes the cases difficult to operate. He says that in Mumbai in last few years thousands of cases of assault and road rage have been registered which means that we need more facilities all over India. Trauma should be handled as soon as possible and also reconstruction surgery should be performed soon after the trauma. At The Esthetic Clinics in Mumbai, Dr.Shome handles a wide spectrum of cases of trauma surgery. In Mumbai, patients visit from various cities of India, in which because of lack of facilities, there is no treatment or surgery available. Dr. Shome is one of the top experts in India who is best qualified to perform various types of facial reconstructive surgeries. He is a visiting consultant to top hospitals in Mumbai and handles various complicated surgery cases in Mumbai. Any type of trauma, if not handled properly, can cause permanent damage without any surgery. If you have suffered any injury for which you do not have best treatments in your city, then come to Mumbai. Mumbai has some of the best facilities in India. Dr. Debraj Shome is a famous surgeon of India and he performs the best post- trauma reconstructive surgery on patients in Mumbai who come from various cities of India. Wrong treatment and surgery is not uncommon in India and if you are not sure about the treatment you should consult Dr. Shome. Sometimes, wrong treatment may prolong recovery period after the first trauma surgery and if you feel that you should get the best surgery then come for consultation in Mumbai. The Esthetic Clinics which are in Mumbai are fast gaining fame for the best facilities for surgery that they provide to their patients in Mumbai. Trauma may be life- altering but correct treatment and surgery after trauma can improve the aesthetics and function of various features of face. For this, there is no one better than Dr.Shome for surgery in Mumbai.