| Facial Injuries
		
			| Topic Overview At one time or another, everyone has had a minor facial injury that
		caused pain, swelling, or bruising. Home treatment is
		usually all that is needed for mild bumps or bruises. Causes of facial injuriesFacial 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.
			 Falls.Fights.
 In children, most facial injuries occur during sports or
		play or are caused by 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. But 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 be sure 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 injuriesFacial 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. But 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.Broken bones, such as 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.
 TreatmentTreatment 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. Check your symptoms to decide
		if and when you should see a doctor.Check Your SymptomsHave you had an injury to your face in the past 2 weeks? Yes Facial injury in the past 2 weeksNo Facial injury in the past 2 weeksHow old are you? Less than 12 years Less than 12 years12 years or older 12 years or olderDo you have an eye injury?Did you injure your nose?Did you pass out completely (lose consciousness)?If you are answering for someone else: Is the person unconscious now? (If you are answering this question for yourself, say no.)Are you back to your normal level of alertness? After passing out, it's normal to feel a little confused, weak, or lightheaded when you first wake up or come to. But unless something else is wrong, these symptoms should pass pretty quickly and you should soon feel about as awake and alert as you normally do. Yes Has returned to normal after loss of consciousnessNo Has returned to normal after loss of consciousnessDid the loss of consciousness occur during the past 24 hours? Yes Loss of consciousness in past 24 hoursNo Loss of consciousness in past 24 hoursDo you have symptoms of shock?Are you having trouble breathing  (more than a stuffy nose)?Yes Difficulty breathing more than a stuffy noseNo Difficulty breathing more than a stuffy noseWould you describe the breathing problem as severe, moderate, or mild? Severe Severe difficulty breathingModerate Moderate difficulty breathingMild Mild difficulty breathingDo you think there could be a spinal cord injury ?Yes Possible spinal cord injuryNo Possible spinal cord injuryIs the wound bleeding? If you think the wound may need stitches, it's best to get them within 8 hours of the injury.Have you had any new vision changes?  These could include vision loss, double vision, or new trouble seeing clearly.Did you have a sudden loss of vision? A loss of vision means that you cannot see out of the eye or out of some part of the eye. The vision in that area is gone.Do you still have vision loss? Yes Vision loss still presentNo Vision loss still presentDid the vision loss occur within the past day? Yes Vision loss occurred in the past dayNo Vision loss occurred in the past dayHave you had double vision?Are you seeing double now? Yes Double vision now presentNo Double vision now presentDid the double vision occur within the past day? Yes Double vision occurred in the past dayNo Double vision occurred in the past dayAre you having trouble seeing? This means you are having new problems reading ordinary print or seeing things at a distance.Is it hard to swallow or talk? Yes Trouble swallowing or talkingNo Trouble swallowing or talkingDoes one side of your face sag or droop? Yes One side of face sags or droopsNo One side of face sags or droopsDo you think that the injury may have been caused by abuse? Yes Injury may have been caused by abuseNo Injury may have been caused by abuseIs there any numbness or tingling in your face? Yes Facial numbness or tinglingNo Facial numbness or tinglingDoes your face have a cut or puncture wound? Yes Cut or puncture wound on faceNo Cut or puncture wound on faceCan you see bone, pieces of bone, or any objects in the wound? Yes Bones, bone fragments, or objects in woundNo Bones, bone fragments, or objects in woundIs the cut or wound more than 0.25 in. (0.6 cm) deep and 0.75 in. (2.0 cm) long with sides that gape open? Wounds like this often need stitches. If you need stitches, it's best to get them within 8 hours of the injury. Yes Cut more than 0.25 in. (0.6 cm) deep and 0.75 in. (2.0 cm) long with sides that gape openNo Cut more than 0.25 in. (0.6 cm) deep and 0.75 in. (2.0 cm) long with sides that gape openAre you worried about scarring ?Yes Worried about scarringDo you think you may have a broken jaw? If your jaw is broken, your top and bottom teeth may not fit together the way they did, or some of your teeth may be loose. Yes Possible broken jawboneNo Possible broken jawboneIs your jaw locked? This means that you can't close it. Do you have any pain in your face?How bad is the pain on a scale of 0 to 10, if 0 is no pain and 10 is the worst pain you can imagine? 8 to 10: Severe pain Severe pain5 to 7: Moderate pain Moderate pain1 to 4: Mild pain Mild painDo you think you may have a fever?Are there red streaks leading away from the area or pus draining from it?Do you have diabetes, a weakened immune system , or any surgical hardware in the area?"Hardware" in the facial area includes things like cochlear implants or any plates under the skin, such as those used if the bones in the face are broken. Yes Diabetes, immune problems, or surgical hardware in affected areaNo Diabetes, immune problems, or surgical hardware in affected areaIs there any swelling or bruising?Does the cheekbone, nose, or eye socket look different than it did before the injury? For example, the nose or cheekbone might look crooked or out of place, and the eye socket may not be the same shape it was before. Yes Cheekbone, nose, or eye socket looks misshapenNo Cheekbone, nose, or eye socket looks misshapenYes Symptoms of skull fractureNo Symptoms of skull fractureIs there any bruising under the tongue?Have your symptoms lasted longer than 1 week? Yes Symptoms have lasted longer than 1 weekNo Symptoms have lasted longer than 1 weekMany things can affect how your body responds to a symptom and what kind
	 of care you may need. These include: Your age. Babies and older
		adults tend to get sicker quicker.Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart
		disease, you may need to pay closer attention to certain symptoms and seek care
		sooner.Medicines you take. Certain
		medicines, herbal remedies, and supplements can cause symptoms or make them
		worse.Recent health events, such as surgery
		or injury. These kinds of events can cause symptoms afterwards or make them
		more serious.Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug
		use, sexual history, and travel. 
Try Home TreatmentYou have answered all the questions. Based on your answers, you may be
		able to take care of this problem at home. Try home treatment to relieve the
		  symptoms. Call your doctor if symptoms get worse or you have any
		  concerns (for example, if symptoms are not getting better as you would expect).
		  You may need care sooner.
Shock is a life-threatening condition that may quickly occur
	 after a sudden illness or injury.  Symptoms of shock (most of which will be present) include: Passing out (losing consciousness).Feeling very dizzy or
		lightheaded, like you may pass out.Feeling very weak or having
		trouble standing.Not feeling alert or able to think clearly. You
		may be confused, restless, fearful, or unable to respond to questions.
Shock is a life-threatening condition that may occur quickly
	 after a sudden illness or injury.  Symptoms of shock in a child may include: Passing out (losing consciousness).Being very sleepy or hard
		to wake up. Not responding when being touched or talked to.
		Breathing much faster than usual. Acting confused.
		The child may not know where he or she is. 
Pain in adults and older children Severe pain (8 to 10): The pain
		is so bad that you can't stand it for more than a few hours, can't sleep, and
		can't do anything else except focus on the pain. Moderate pain (5 to 7): The pain is bad enough to disrupt your
		normal activities and your sleep, but you can tolerate it for hours or days.
		Moderate can also mean pain that comes and goes even if it's severe when it's
		there.Mild pain (1 to 4): You notice the pain,
		but it is not bad enough to disrupt your sleep or activities. 
Pain in children under 3 years It can be hard to tell how much pain a baby or toddler is in. Severe pain (8 to 10): The
		pain is so bad that the baby cannot sleep, cannot get comfortable, and cries
		constantly no matter what you do. The baby may kick, make fists, or
		grimace.Moderate pain (5 to 7): The baby is
		very fussy, clings to you a lot, and may have trouble sleeping but responds
		when you try to comfort him or her.Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds
		when you try to comfort him or her. 
You may need a tetanus shot depending
	 on how dirty the wound is and how long it has been since your last shot. For a dirty wound that has
		things like dirt, saliva, or feces in it, you may need a shot if: 
		You haven't had a tetanus shot in the past 5
			 years. You don't know when your last shot was.
For a clean wound, you may
		need a shot if: 
		You have not had a tetanus shot in the past 10
			 years.You don't know when your last shot was.
Symptoms of infection may
	 include: Increased pain, swelling, warmth, or redness in or
		around the area.Red streaks leading from the area.
		Pus draining from the area. A fever.
Symptoms of a spinal cord injury in an
	 adult or older child may include: Severe neck or back pain.Not being
		able to move a part of the body. (This is not the same as being unable to move
		because of pain or because of a direct injury to that
		area.)Weakness, tingling, or numbness in the arms or
		legs.New loss of bowel or bladder control.
With severe bleeding, any of these may
	 be true: Blood is pumping from the wound.The
		bleeding does not stop or slow down with pressure.Blood is quickly soaking through bandage after bandage.
 With moderate bleeding, any of these may
	 be true: The bleeding slows or stops with pressure but
		starts again if you remove the pressure.The blood may soak through
		a few bandages, but it is not fast or out of control.
 With mild bleeding, any of these may be
	 true: The bleeding stops on its own or with
		pressure.The bleeding stops or slows to an ooze or trickle after
		15 minutes of pressure. It may ooze or trickle for up to 45 minutes.
Some types of facial wounds are more likely to leave a scar than others. These include: Jagged wounds on the face.Cuts on the eyelids.Cuts to the lips, especially if they cut through the edge of the lip.
 Stitches or other treatment may help prevent scarring. It's best to get treated within 8 hours of the injury.Symptoms of a skull fracture may
	 include: Clear or bloody fluid draining from the ears or
		nose.Bruising under the eyes or behind the
		ears.Drooping of the face.A dent anywhere on the head.
Symptoms of difficulty breathing can range from mild to severe. For example: You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).
Severe trouble breathing means:
	  You cannot talk at all. You have to
		work very hard to breathe.You feel like you can't get enough
		air.You do not feel alert or cannot think clearly. 
 Moderate trouble breathing means: It's hard to talk in full
		sentences.It's hard to breathe with activity. 
 Mild trouble breathing means: You feel a little out of breath but can still talk.
		It's becoming hard to breathe with activity. 
Severe trouble breathing means: The child cannot eat or talk because he or she is
		breathing so hard. The child's nostrils are flaring and the belly
		is moving in and out with every breath.The child seems to be
		tiring out. The child seems very sleepy or confused. 
 Moderate trouble breathing means: The child is breathing a lot faster than
		usual.The child has to take breaks from eating or talking to
		breathe. The nostrils flare or the belly moves in and out at times
		when the child breathes. 
 Mild trouble breathing means: The child is breathing a little faster than usual.
		The child seems a little out of breath but can still eat or talk.
		
Certain health conditions and medicines weaken the immune system's ability to fight off infection and
	 illness. Some examples in adults are: Diseases such as diabetes, cancer, heart disease,
		and HIV/AIDS.Long-term alcohol and drug
		problems.Steroid medicines, which may be used to treat a variety
		of conditions.Chemotherapy and radiation therapy for
		cancer.Other medicines used to treat autoimmune
		disease.Medicines taken after organ transplant.Not
		having a spleen.
Seek Care NowBased on your answers, you may need care right away. The problem is likely to get worse without medical care.Call your doctor now to discuss the symptoms and
		  arrange for care.If you cannot reach your doctor or you don't have
		  one, seek care in the next hour.You do not need to call an
		  ambulance unless: 
		  You cannot travel safely either by driving
				yourself or by having someone else drive you.You are in an area
				where heavy traffic or other problems may slow you down.
Call  911  NowBased on your answers, you need
		emergency care.Call911or other emergency services now.Seek Care TodayBased on your answers, you may need care soon. The
		problem probably will not get better without medical care.Call your doctor today to discuss the symptoms
		  and arrange for care.If you cannot reach your doctor or you don't
		  have one, seek care today.If it is evening, watch the symptoms and
		  seek care in the morning.If the symptoms get worse, seek care
		  sooner.
Call  911  NowBased on your answers, you need
		emergency care.Call911or other emergency services now.Do not move the person unless there is an immediate threat to the person's life, such as
		a fire. If you have to move the person, keep the head and neck supported and in
		a straight line at all times. If the person has had a diving accident and is
		still in the water, float the person face up in the water.Call  911  NowBased on your answers, you need
		emergency care. Call911or other emergency services now.Put direct, steady pressure on the
		wound until help arrives. Keep the area raised if you can.Make an Appointment Based on your answers, the problem may not improve without medical
		care.Make an appointment to see your doctor in the
		  next 1 to 2 weeks.  If appropriate, try home treatment while you
		  are waiting for the appointment.If symptoms get worse or you have
		  any concerns, call your doctor. You may need care sooner.
Eye Injuries Nose InjuriesHome TreatmentHome treatment may help treat
		problems and prevent complications after an injury to your face. First aid for bleedingFacial injuries can bleed a lot even if they are minor injuries. Stop any  bleeding from the nose, mouth, or face so you can see what the injury is. 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. First aid for a suspected broken boneDo 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 bruisingUse 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 Smoking.  Medicine you can buy without a prescription| Try a nonprescription
			 medicine to help treat your fever or pain: | 
|---|
 | Talk to your child's doctor before switching back and
				forth between doses of acetaminophen and ibuprofen. When you switch between two
				medicines, there is a chance your child will get too much medicine. |  Safety tips| Be sure to follow these
				safety tips when you use a nonprescription medicine: | 
|---|
 | Carefully read and follow all directions
					 on the medicine bottle and box.Do not take more than the
					 recommended dose.Do not take a medicine if you have had an
					 allergic reaction to it in the past.If
					 you have been told to avoid a medicine, call your doctor before you take
					 it.If you are or could be pregnant, do not take any medicine other
					 than acetaminophen unless your doctor has told you to.Do not give aspirin to anyone younger than age 20 unless your doctor tells you to. 
					 
 |  Symptoms to watch for during home treatmentCall your doctor if any of the following symptoms occur during
		  home treatment: Numbness or tingling
			 develop.Changes in vision develop, such as double
			 vision or blurring.Signs of infection
			 develop.Pain and swelling continue or get worse.Symptoms become more severe or frequent.
PreventionThere 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 crash.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. Make sure your children also wear helmets and protective clothing to prevent sports injuries.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
		  guns in your home. If you must keep
		  guns, 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, or 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 hard for your child to walk
		  on.When your toddler is using a bottle or sippy cup, have him or her stay seated. This can help prevent injuries that might occur if your child were to fall while walking and holding a bottle or a cup.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.
Preparing For Your AppointmentTo prepare for your appointment, see the topic Making the Most of Your Appointment. You can help your
		doctor 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 doctor?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?
CreditsByHealthwise StaffPrimary Medical ReviewerWilliam H. Blahd, Jr., MD, FACEP - Emergency Medicine
 Adam Husney, MD - Family Medicine
 Kathleen Romito, MD - Family Medicine
Current as ofMarch 20, 2017Current as of:
                March 20, 2017 Last modified on: 8 September 2017  |  |