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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 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.
  • 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 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. 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.

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.

Check your symptoms to decide if and when you should see a doctor.

Check Your Symptoms

Have you had an injury to your face in the past 2 weeks?
Yes
Facial injury in the past 2 weeks
No
Facial injury in the past 2 weeks
How old are you?
Less than 12 years
Less than 12 years
12 years or older
12 years or older
Are you male or female?
Male
Male
Female
Female
Do you have an eye injury?
Yes
Eye injury
No
Eye injury
Did you injure your nose?
Yes
Nose injury
No
Nose injury
Did you pass out completely (lose consciousness)?
Yes
Lost consciousness
No
Lost consciousness
If you are answering for someone else: Is the person unconscious now?
(If you are answering this question for yourself, say no.)
Yes
Unconscious now
No
Unconscious now
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 consciousness
No
Has returned to normal after loss of consciousness
Did the loss of consciousness occur during the past 24 hours?
Yes
Loss of consciousness in past 24 hours
No
Loss of consciousness in past 24 hours
Do you have symptoms of shock?
Yes
Symptoms of shock
No
Symptoms of shock
Are you having trouble breathing (more than a stuffy nose)?
Yes
Difficulty breathing more than a stuffy nose
No
Difficulty breathing more than a stuffy nose
Would you describe the breathing problem as severe, moderate, or mild?
Severe
Severe difficulty breathing
Moderate
Moderate difficulty breathing
Mild
Mild difficulty breathing
Have you had a seizure?
Yes
Seizure
No
Seizure
Do you think there could be a spinal cord injury?
Yes
Possible spinal cord injury
No
Possible spinal cord injury
Is the wound bleeding?
If you think the wound may need stitches, it's best to get them within 8 hours of the injury.
Yes
Bleeding wound
No
Bleeding wound
Would you describe the bleeding as severe, moderate, or mild?
Severe
Severe bleeding
Moderate
Moderate bleeding
Mild
Mild bleeding
Have you had any new vision changes?
These could include vision loss, double vision, or new trouble seeing clearly.
Yes
New vision changes
No
New vision changes
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.
Yes
Sudden vision loss
No
Sudden vision loss
Do you still have vision loss?
Yes
Vision loss still present
No
Vision loss still present
Did the vision loss occur within the past day?
Yes
Vision loss occurred in the past day
No
Vision loss occurred in the past day
Have you had double vision?
Yes
Double vision
No
Double vision
Are you seeing double now?
Yes
Double vision now present
No
Double vision now present
Did the double vision occur within the past day?
Yes
Double vision occurred in the past day
No
Double vision occurred in the past day
Are you having trouble seeing?
This means you are having new problems reading ordinary print or seeing things at a distance.
Yes
Decreased vision
No
Decreased vision
Is it hard to swallow or talk?
Yes
Trouble swallowing or talking
No
Trouble swallowing or talking
Does one side of your face sag or droop?
Yes
One side of face sags or droops
No
One side of face sags or droops
Do you think that the injury may have been caused by abuse?
Yes
Injury may have been caused by abuse
No
Injury may have been caused by abuse
Is there any numbness or tingling in your face?
Yes
Facial numbness or tingling
No
Facial numbness or tingling
Does your face have a cut or puncture wound?
Yes
Cut or puncture wound on face
No
Cut or puncture wound on face
Can you see bone, pieces of bone, or any objects in the wound?
Yes
Bones, bone fragments, or objects in wound
No
Bones, bone fragments, or objects in wound
Is 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 open
No
Cut more than 0.25 in. (0.6 cm) deep and 0.75 in. (2.0 cm) long with sides that gape open
Are you worried about scarring?
Yes
Worried about scarring
No
Worried about scarring
Do you think you may need a tetanus shot?
Yes
May need tetanus shot
No
May need tetanus shot
Have you hurt your jaw?
Yes
Jaw injury
No
Jaw injury
Do 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 jawbone
No
Possible broken jawbone
Is your jaw locked?
This means that you can't close it.
Yes
Locked jaw
No
Locked jaw
Do you have any pain in your face?
Yes
Facial pain
No
Facial pain
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 pain
5 to 7: Moderate pain
Moderate pain
1 to 4: Mild pain
Mild pain
Are there any symptoms of infection?
Yes
Symptoms of infection
No
Symptoms of infection
Do you think you may have a fever?
Yes
Possible fever
No
Possible fever
Are there red streaks leading away from the area or pus draining from it?
Yes
Red streaks or pus
No
Red streaks or pus
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 area
No
Diabetes, immune problems, or surgical hardware in affected area
Is there any swelling or bruising?
Yes
Swelling or bruising
No
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 misshapen
No
Cheekbone, nose, or eye socket looks misshapen
Yes
Symptoms of skull fracture
No
Symptoms of skull fracture
Is there any bruising under the tongue?
Yes
Bruising under tongue
No
Bruising under tongue
Have your symptoms lasted longer than 1 week?
Yes
Symptoms have lasted longer than 1 week
No
Symptoms have lasted longer than 1 week

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.

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.

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.

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.
Eye Injuries

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.
  • 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.

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).

Seek Care Now

Based 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.

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.

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.

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.

Call 911 Now

Based 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.

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.

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.
  • 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.
Nose Injuries

Try Home Treatment

You 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.

Many 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.

Call 911 Now

Based on your answers, you need emergency care.

Call911or other emergency services now.

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.

Call 911 Now

Based 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.

Seek Care Today

Based 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.

Home Treatment

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

First aid for bleeding

Facial 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 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 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 treatment

Call 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.

Prevention

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 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 Appointment

To 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?

Credits

By Healthwise Staff
William H. Blahd, Jr., MD, FACEP - Emergency Medicine
David Messenger, MD
Last Revised April 3, 2013

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

© 1995-2014 Healthwise, Incorporated. Healthwise, Healthwise for every health decision, and the Healthwise logo are trademarks of Healthwise, Incorporated.

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