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Facial trauma, airway first, then a specialist repair.

From nasal fractures and orbital blowouts to Le Fort injuries and complex soft tissue wounds - facial trauma is best managed by a coordinated UK maxillofacial team.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Editorial team

    Written by our editorial team from the UK sources listed on each page.

  • 02

    Sourced from guidance

    Checked against NICE, BAOMS, BAPRAS, BOAST and Royal College standards you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK maxillofacial and trauma practice including ATLS, BOAST 4 for open fractures and specialist commissioned centres.

Key facts

Facial trauma at a glance.

The essentials, in plain English - the fracture patterns, the nerves at risk, and how UK maxillofacial teams work.

  • What it is

    Injury to the face involving skin, soft tissue, facial bones, teeth, eyes, nerves and the airway - from assault, road traffic collisions, sport, falls or industry.

  • Airway first

    Blood, swelling and bilateral mandibular fractures can obstruct the airway - primary survey and ATLS come before cosmetic repair.

  • Fracture patterns

    Mandible (most common), nasal bones, zygomatic-maxillary-orbital complex, orbital blowout, Le Fort I to III, frontal sinus and naso-ethmoidal.

  • Nerve at risk

    V2 (infraorbital) with zygomatic and orbital injury, V3 (inferior alveolar) with mandibular fracture, facial nerve with parotid laceration.

  • Sight-threatening

    Retrobulbar haematoma is a true emergency - lateral canthotomy and cantholysis within minutes can save vision.

  • Specialist pathway

    Managed jointly by maxillofacial, plastic, ENT, ophthalmology and neurosurgery in commissioned facial trauma centres.

Why this guide matters

Airway, sight, structure - in that order.

Facial injury looks dramatic and often is - but the order in which it is treated is the same across UK trauma centres. Three principles shape everything else.

  • Airway is always first

    Blood, swelling and bilateral mandibular injury can obstruct the airway - primary survey and ATLS come before any facial repair.

  • Sight-threatening injury is urgent

    Retrobulbar haematoma, orbital compartment syndrome and optic nerve injury are minutes-count emergencies.

  • Reconstruction is a team sport

    Maxillofacial, plastic, ENT, ophthalmology and neurosurgery each own part of the face - the best outcomes come from coordinated care.

How the diagnosis is made

From resus bay to a definitive plan.

The steps a UK trauma and maxillofacial team will normally follow, in order - so you know what to expect and why.

  1. 01

    Resuscitation

    Primary survey (ATLS)

    Airway with C-spine control, breathing, circulation, disability and exposure - facial injury is never assessed before the airway is secured.

  2. 02

    Resuscitation

    C-spine precautions

    High-energy facial trauma carries a real risk of cervical spine injury - immobilisation stays until cleared clinically or by CT.

  3. 03

    Resuscitation

    Structured examination

    Inspection for asymmetry and step deformity, palpation of every buttress, cranial nerves, eye exam, occlusion and intra-oral check.

  4. 04

    Imaging

    CT face and cervical spine

    CT of the facial skeleton is the gold standard for bony injury - paired with CT c-spine and CT brain in the unconscious or high-energy patient.

  5. 05

    Imaging

    OPG and dental imaging

    Orthopantomogram (OPG) is added for suspected mandibular or dento-alveolar injury - occlusal and periapical films for dental fractures.

  6. 06

    Records

    Specialist review

    Maxillofacial, ophthalmology, ENT, plastics and neurosurgery are involved early - the mix depends on the pattern of injury.

  7. 07

    Records

    Photograph and safeguard

    Clinical photography for medicolegal, assault and safeguarding records - domestic abuse and non-accidental injury are actively screened for.

Typical timeline: from arrival to a definitive surgical plan within hours.

Symptoms

What facial trauma looks like.

The classic mix of swelling, deformity, altered occlusion and eye or nerve involvement - and the features that mean it is time to escalate immediately.

  • Swelling and bruising

    Peri-orbital and facial swelling, bruising and haematoma - can obscure underlying step deformity for hours or days.

  • Step deformity and palpable defect

    A palpable step at the infraorbital rim, zygomatic arch or mandibular border points to a displaced fracture.

  • Malocclusion and trismus

    The teeth no longer meet as they should, or the mouth will not open fully - a strong signal of mandibular or maxillary injury.

  • Diplopia and enophthalmos

    Double vision or a sunken eye after blunt orbital trauma suggests a blowout fracture with inferior rectus entrapment or orbital volume loss.

  • Numbness (V2 and V3)

    Infraorbital numbness with zygomatic or orbital fractures, chin and lower lip numbness with mandibular body or angle fractures.

  • Subconjunctival haemorrhage

    Blood tracking under the conjunctiva after facial trauma raises suspicion of orbital or zygomatic fracture.

  • Epistaxis and CSF rhinorrhoea

    A clear watery discharge from the nose after facial or head trauma may be cerebrospinal fluid - a marker of skull base injury.

  • Red flag - airway or vision loss

    Stridor, drooling, an inability to lie flat, or acute loss of vision needs immediate senior review and specialist input.

Treatment

How facial trauma is treated in the UK.

Emergency airway and resuscitation, meticulous soft tissue repair, then bony reconstruction by a coordinated specialist team - with dental and ophthalmology support where needed.

  • Airway and resuscitation

    Rapid sequence induction, surgical airway if needed, C-spine control, IV access and imaging - specialist anaesthetic, ENT and maxillofacial input.

  • Nasal fracture reduction

    Closed reduction 5 to 14 days after swelling settles under specialist ENT - septoplasty reserved for persistent obstruction or deviation.

  • Mandibular ORIF

    Open reduction and internal fixation with plates, sometimes with intermaxillary fixation, by a maxillofacial surgeon.

  • Le Fort fixation

    Maxillary fractures (Le Fort I, II or III) are reduced and plated to restore occlusion and midface projection.

  • ZMC and orbital reconstruction

    Zygomatic-maxillary-orbital fractures are reduced via lower eyelid or gingivobuccal approaches with an orbital floor plate or mesh where needed.

  • Emergency canthotomy

    Retrobulbar haematoma is treated within minutes by lateral canthotomy and cantholysis to relieve pressure - specialist emergency ophthalmology.

  • Dental and TMJ care

    Avulsed teeth are re-implanted and splinted urgently, luxation and alveolar fractures are managed by specialist dental teams, TMJ dislocation is reduced.

Related pages: deviated septum, CSF leak, and treatments including mandibular fracture fixation, plastic surgery reconstruction, septoplasty and facial reanimation surgery.

What this guide is based on

The sources behind every claim on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

If you or someone else has significant facial injury, go to an emergency department or call 999. Trauma teams need to see and image the injury quickly.

  • NICE. Head injury: assessment and early management (NG232).

  • BAOMS. Standards for the management of maxillofacial trauma.

  • BOAST. Open fractures (BOAST 4) and management of severe open lower limb and facial fractures.

  • Royal College of Ophthalmologists. Guidance on orbital compartment syndrome and lateral canthotomy.

  • Royal College of Surgeons. Standards for major trauma and facial injury commissioning.

Red flags

When facial trauma needs urgent attention.

Most facial injuries need timely specialist review - these features push the case to minutes-count emergency.

  • Airway compromise

    Stridor, drooling, an inability to lie flat, or bilateral mandibular fractures with a flail segment - senior airway support immediately.

  • Retrobulbar haematoma

    Acute proptosis, tense globe, pain and loss of vision after facial trauma - lateral canthotomy and cantholysis within minutes.

  • Vision loss or afferent pupil defect

    Any loss of visual acuity, colour vision or a new relative afferent pupillary defect - urgent ophthalmology and imaging.

  • CSF rhinorrhoea or otorrhoea

    Clear watery leak from the nose or ear points to a skull base fracture - neurosurgery and ENT review.

  • Superior orbital fissure syndrome

    Ophthalmoplegia, ptosis, forehead numbness and a fixed pupil after orbital trauma - urgent specialist decompression may be needed.

  • Orbital apex syndrome

    Superior orbital fissure signs plus optic nerve involvement (visual loss) - a sight-threatening emergency.

  • Cervical spine injury

    High-energy facial trauma carries a real risk - keep immobilisation until cleared clinically or on CT.

  • Non-accidental injury and safeguarding

    Facial injury from assault, domestic abuse or non-accidental injury (adult or child) needs safeguarding review and documentation.

Living with it

Recovery is a team effort.

Facial trauma affects appearance, function and confidence - most people do very well with structured MDT rehabilitation.

A quiet reminder

The face heals - so does confidence.

Ask for psychological support early if you need it. It is a routine part of trauma recovery in the UK, not a sign of weakness.

  1. 01 Recovery

    Swelling settles in weeks

    Most facial swelling and bruising resolves over 2 to 6 weeks - final aesthetic outcome is judged at 6 to 12 months.

  2. 02 Function

    Bite, breathing and vision

    Occlusion, nasal breathing, eye movement and sensation are monitored at follow-up - persistent problems need specialist review.

  3. 03 Support

    Psychology matters

    Facial injury can leave real psychological scars - PTSD, altered body image and anxiety are common and treatable.

  4. 04 Long term

    MDT follow-up

    Rehabilitation may involve maxillofacial, plastic, oculoplastic, ENT, speech and language, occupational therapy and psychology.

Frequently asked

Everything we get asked about facial trauma.

Quick answers on fracture patterns, blowout injuries, retrobulbar haematoma and open fractures.

  • What counts as facial trauma?

    Any injury to the face - skin lacerations, soft tissue haematoma, fractures of the mandible, maxilla, zygoma, orbit, nasal bones or frontal sinus, dental and dento-alveolar injury, temporomandibular dislocation and skull base fracture. It is managed by a coordinated maxillofacial, plastic, ENT, ophthalmology and neurosurgery team.

  • What is the most common facial fracture?

    The mandible (lower jaw) is the most commonly fractured facial bone in the UK, followed by nasal bones and the zygomatic-maxillary-orbital complex. Assault is the leading cause in adults, with road traffic collisions, falls and sport also common.

  • What are Le Fort fractures?

    Le Fort fractures describe classic patterns of midface injury: Le Fort I is a transverse fracture through the maxilla above the teeth, Le Fort II is a pyramidal fracture through the nasal bridge and infraorbital rims, and Le Fort III is craniofacial disjunction separating the entire midface from the skull base.

  • What is a blowout fracture?

    An orbital blowout fracture is a break in the thin orbital floor or medial wall from a blow to the eye. It can trap the inferior rectus muscle causing double vision, or lead to a sunken eye (enophthalmos). Persistent diplopia or significant enophthalmos usually needs surgical repair with an orbital floor plate or mesh.

  • What is retrobulbar haematoma and why does it matter?

    Retrobulbar haematoma is bleeding behind the eye that raises intra-orbital pressure and can cut off blood supply to the optic nerve. It causes a tense, proptotic eye with rapidly worsening vision. It is a true emergency treated within minutes by lateral canthotomy and cantholysis - waiting risks permanent blindness.

  • How are open facial fractures managed?

    Delay increases infection, malunion and cosmetic problems.

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