Health Library Facial InjuriesFrom Healthwise

Everyone has had a minor facial injury that caused pain, swelling, or bruising at one time or another. Home treatment is usually all that is needed for mild bumps or bruises.

It may be helpful to be familiar with the makeup of the facial bones to better understand facial injuries. See a picture of the facial bones.

Causes of facial injuries

Facial injuries most commonly occur during:

• Sports or recreational activities, such as ice hockey, basketball, rugby, soccer, or martial arts.
• Work-related tasks or projects around the home.
• Motor vehicle crashes.
• Accidental falls.
• Fights.

In children, most facial injuries occur during sports or play or are caused by accidental falls. Minor facial injuries in young children tend to be less severe than similar facial injuries that occur in older children or adults. Young children are less likely to break a facial bone because they have fat pads that cushion their faces and their bones are more flexible. However, young children are more likely to be bitten in the face by an animal.

Head injuries may occur at the same time as a facial injury, so it is important to check for symptoms of a head injury. For more information, see the topic Head Injuries, Age 3 and Younger or Head Injuries, Age 4 and Older.

Types of injuries

Facial injuries may be caused by a direct blow, penetrating injury, or fall. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

• A cut or puncture to your face or inside your mouth. This often occurs with even a minor injury. However, a cut or puncture is likely to occur when a jaw or facial bone is broken. The bone may come through the skin or poke into the mouth.
• Bruises from a tear or rupture of small blood vessels under the skin. See a picture of a bruise (contusion).
• Broken bones (fractures). See an image of a fractured cheekbone.
• A dislocated jaw, which may occur when the lower jawbone (mandible) is pulled apart from one or both of the joints connecting it to the base of the skull at the temporomandibular (TM) joints. This can cause problems even if the jaw pops back into place.

Treatment

Treatment for a facial injury may include first aid measures, medicine, and in some cases, surgery. Treatment depends on:

• The location, type, and severity of the injury.
• How long ago the injury occurred.
• Your age, health condition, and other activities, such as work, sports, or hobbies.

When you have had a facial injury, it is important to look for signs of other injuries, such as a spinal injury, eye injury, or an injury to the mouth, such as a cut lip or injured tooth.

Review the Emergencies and Check Your Symptoms sections to determine if and when you need to see a health professional.

• Breathing stops for longer than 30 seconds. After calling 911 or other emergency services, see the topic Dealing With Emergencies.
• Unconsciousness
• Signs of moderate to severe difficulty breathing:
  • In a child
  • In an adult and older child
• Gunshot or stab wound
• Signs of shock:
  • In a child
  • In an adult and older child
• Signs of a serious head injury
• Signs of a spinal injury
• Severe bleeding does not slow during the first 15 minutes of steady direct pressure.
• Seizure
• Sudden partial or complete vision loss in one or both eyes. Note: Treatment is needed within 90 minutes to save vision.
• Sudden facial paralysis

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first.

• A head injury: Go to the topic Head Injury, Age 4 and Older or Head Injury, Age 3 and Younger.
• Eye injury: Go to the topic Eye Injuries.
• Nose injury: Go to the topic Nose Injuries.
• A mouth or dental injury: Go to the topic Mouth and Dental Injuries.

	Yes	Do you have any difficulty breathing, talking, or swallowing?
When to See a Doctor See significance of difficulty breathing, talking, or swallowing if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Are you having mild difficulty breathing? Yes Are you having trouble talking or swallowing normally? Yes Are you drooling and having trouble swallowing your own saliva? Yes Is your baby age 3 months or younger having any difficulty breathing, even from nasal stuffiness? Call your health professional today if you answer "Yes" to the following question. Yes Are you having trouble breathing through your nose because of nasal stuffiness, but you are able to breathe through your mouth without difficulty? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had mild difficulty breathing off and on through your nose for 24 hours? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have a cut or puncture wound on your face?
When to See a Doctor See significance of a cut or puncture wound if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Can you see bone or pieces of bones in your wound or sticking out of your wound? Yes Do you have a object stuck in cut or puncture wound? Yes Do you have a cut or puncture wound more than 0.25 in. (0.6 cm) deep and 0.75 in. (1.9 cm) long with jagged edges or the cut gapes open? Note: Most deep cuts need to be evaluated by a health professional and should be stitched, stapled, or closed with skin adhesives within 6 to 8 hours after the injury. Some cuts that require closure can be closed as long as 24 hours after the injury. For more information, see are stitches, staples, or skin adhesives necessary? Call your health professional today if you answer "Yes" to the following question. Yes Do you have a cut on the face, eyelids, lips, or another area that you are worried may scar? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your face look misshapen or swollen after an injury?
When to See a Doctor See significance of misshapen or swollen face if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Does your cheekbone, nose, or eye socket look misshapen? Call your health professional today if you answer "Yes" to any of the following questions. Yes Did a lot of facial swelling develop within 30 minutes after a facial injury? Yes Do you have moderate facial swelling after 12 hours of home treatment? Yes Do you have facial swelling with any signs of infection? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had a jaw injury?
When to See a Doctor See significance of a jaw injury if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have a broken jawbone with open skin over the fracture site? Yes Do you have a broken jawbone and loose teeth? Yes Do you have a broken jawbone and bleeding in the mouth? Yes Do you have a broken jawbone, and your teeth are out of alignment (malocclusion)? Yes Is your jaw locked in an open or closed position and you cannot unlock it? Call your health professional today if you answer "Yes" to any of the following questions. Yes Is your lower lip numb? Yes Do you have one or two spots of tenderness (focal pain) in your jaw? Yes Are you having trouble moving your jaw normally, such as opening or closing your mouth? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had painful clicking, popping, or grating when you open and close your jaw for longer than 24 hours? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have facial pain?
When to See a Doctor See significance of facial pain if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have severe pain? Call your health professional today if you answer "Yes" to the following question. Yes Do you have moderate pain? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you still have mild pain after 24 hours of home treatment? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have bruising or discoloration behind your ears, around your eyes, or under your tongue?
When to See a Doctor See significance of bruising or discoloration if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you have bruising or discoloration behind an ear or around both your eyes that was not caused by a direct injury to your ears or eyes? Call your health professional today if you answer "Yes" to any of the following questions. Yes Did a lot of facial bruising develop within 30 minutes of a facial injury? Yes Do you have jaw pain and bruising under your tongue? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that a facial injury may have been caused by abuse?
When to See a Doctor See significance of abuse if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to the following question. Yes Do you think that a facial injury may have been caused by abuse? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think you have an infection after a facial injury?
When to See a Doctor See significance of signs of a skin infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have a disease or take a medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased redness or warmth near a facial wound? Yes Do you have red streaks extending from a facial wound? Yes Do you have pus in or around a facial wound? Yes Do you know or think you have a fever? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around a facial wound for 24 hours or longer? Yes Have you had swollen glands (lymph nodes) in the neck or behind your ear for 24 hours or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have facial numbness or tingling after an injury?
When to See a Doctor See significance of numbness or tingling if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you have facial numbness or tingling? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you know or think you need a tetanus shot?
When to See a Doctor See significance of getting a tetanus shot if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: If you need a tetanus shot, call your doctor to arrange for the shot as soon as possible. Your need for a tetanus shot depends on the seriousness of your wound and your tetanus shot history. Your doctor may be able to tell you over the telephone if you need a tetanus shot. Call your health professional today if you answer "Yes" to any of the following questions. Yes Were you cut by something clean and your last tetanus shot was longer than 10 years ago? Note: Something is clean if it does not have dirt, soil, spit, or feces on it. Examples include a broken water glass, a kitchen knife, or sewing scissors. Yes Were you cut by something dirty and your last tetanus shot was longer than 5 years ago? Note: Something is dirty if it has dirt, soil, spit, or feces on it. Examples include a garden tool, a dirty nail, or a piece of glass that has been buried in the dirt. Yes Are you not sure if you were cut by something clean or dirty and your last tetanus shot was longer than 5 years ago? Yes Are you not sure when you had your last tetanus shot? Yes Did you not get the first series of tetanus shots (primary vaccination series)? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• Facial symptoms without an injury: Go to the topic Facial Problems, Noninjury.
• Neck pain: Go to the topic Neck Pain.
• An ear injury: Go to the topic Ear Problems and Injuries, Age 11 and Younger or Ear Problems and Injuries, Age 12 and Older.
• A cut, puncture, scrape, burn, or bite to the face: Go to the topics Cuts, Puncture Wounds, Scrapes, Burns, or Animal and Human Bites.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home treatment may help treat problems and prevent complications after an injury to your face.

First aid for bleeding

Stop the bleeding. Crying increases blood flow to the face and can make a nosebleed or facial bleeding worse. If your injured child is crying, speak in a quiet, relaxed manner to soothe him or her.

• How to stop facial bleeding
• How to stop bleeding in the mouth
• How to stop a nosebleed

First aid for a suspected broken bone

• Do not move misshapen facial bones. It may make an injury worse, increase bleeding, or cause more problems.
• Apply an ice or cold pack immediately to prevent or minimize swelling.
• Seek medical evaluation and treatment.

Measures to reduce pain, swelling, and bruising

• Use ice. Cold will reduce pain and swelling. Apply an ice or cold pack immediately to prevent or minimize swelling. Apply the ice or cold pack for 10 to 20 minutes, 3 or more times a day. After 48 to 72 hours, if swelling is gone, apply warmth to the area that hurts.
• Keep your head elevated, even while you sleep. This will help reduce swelling.
• For the first 48 hours, avoid things that might increase swelling, such as hot showers, hot tubs or hot packs, or drinking alcohol or hot fluids.
• Do not take aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) for the first 24 hours. Aspirin prolongs the clotting time of blood and may cause more nose or facial bleeding.
• Eat soft foods and cold foods and fluids to reduce jaw and mouth pain. Avoid hot foods or beverages, which may increase swelling around the mouth.

Do not smoke. Smoking slows healing because it decreases blood supply and delays tissue repair. For more information, see the topic Quitting Tobacco Use.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if one or more of the following symptoms occur during home treatment:

• Changes in vision develop, such as double vision or blurring.
• Signs of infection develop.
• Pain and swelling continue or get worse after using home treatment.
• Symptoms become more severe or frequent.

There are many steps you can take to help prevent a facial injury.

• Always use car safety seats and seat belts to prevent or reduce nose and facial injuries during a car accident. Place your child in an approved child car seat when traveling in a car. Follow the manufacturer's directions for securing the seat in the car. Children should ride in the back seat for safety.
• Do not use alcohol or other drugs before participating in sports or when operating a motor vehicle or other equipment.
• Wear a helmet and other protective clothing whenever you are biking, motorcycling, skating, skateboarding, kayaking, horseback riding, skiing, snowboarding, or rock climbing.
• Wear a mouth protector when you participate in contact sports.
• Wear a hard hat if you work in an industrial area.
• Wear safety glasses, goggles, or face shields when you work with power tools or when you do an activity that might cause an object to fly into your face.
• Do not dive into shallow or unfamiliar water.
• Prevent falls in your home by removing hazards that might cause a fall.
• Do not keep firearms in your home. If you must keep firearms, lock them up and store them unloaded and uncocked. Lock ammunition in a separate area.

You can take steps to help reduce your young child's risk of facial injury.

• Never leave your child unattended in a high place, such as on a tabletop; in a crib with the sides down; on elevated porches, decks, and landings; or even on a bed or sofa.
• Do not leave your child alone in any infant seat or sitting toy, such as a swing or jumper. Use all of the safety straps provided.
• Use stair gates to block stairways. Use gates at the top and bottom of the stairs, and use the gates properly.
• Do not use baby walkers. Baby walkers have caused many injuries and are not safe even if the baby is watched closely.
• Watch your child when he or she is outside. Uneven grass, sloping lawns, and hills may be difficult for your child to walk on.
• Make your home safe from falls by removing hazards that might cause a fall, such as throw rugs.
• Place your child in an approved child car seat when traveling in a car. Follow the manufacturer's directions for securing the seat in the car. Children should ride in the back seat for safety.
• Have your children wear helmets when necessary, such as when they are passengers on a bike or are riding a tricycle or bicycle on their own.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your health professional diagnose and treat your condition by being prepared to answer the following questions:

• When did your injury occur?
• What caused your injury?
• What are your main symptoms?
• What have you done so far to treat your injury?
• Have you had a facial injury in the past?
  • Was your injury evaluated by a health professional?
  • What was the diagnosis?
  • How was your injury treated?
  • Do you have any continuing problems because of the previous injury?
• Was this injury from abuse caused by another person?
• Was the use of alcohol or drugs involved in your injury?
• What home treatment measures have you tried? Did they help?
• What prescription or nonprescription medicines do you take?
• Do you have any health risks?

• Animal and Human Bites
• Body Piercing Problems
• Burns
• Burns to the Eye
• Cuts
• Dealing With Emergencies
• Ear Problems and Injuries, Age 12 and Older
• Eye Injuries
• Facial Problems, Noninjury
• Head Injury, Age 3 and Younger
• Head Injury, Age 4 and Older
• Insect Bites and Stings and Spider Bites
• Mouth and Dental Injuries
• Neck Problems and Injuries
• Nose Injuries
• Nosebleeds
• Puncture Wounds
• Scrapes
• Shock
• Sinusitis
• Sunburn
• Temporomandibular (TM) Disorders

Author:	Jan Nissl, RN, BS	Last Updated: May 15, 2007
Medical Review:	William M. Green, MD - Emergency Medicine H. Michael O'Connor, MD - Emergency Medicine
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