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  "id": "dental-oral-health/oral-maxillofacial-surgery/facial-trauma-jaw-reconstruction-how-oral-maxillofacial-surgeons-restore-form-and-function-after-injury-or-cancer",
  "title": "Facial Trauma & Jaw Reconstruction: How Oral & Maxillofacial Surgeons Restore Form and Function After Injury or Cancer",
  "slug": "dental-oral-health/oral-maxillofacial-surgery/facial-trauma-jaw-reconstruction-how-oral-maxillofacial-surgeons-restore-form-and-function-after-injury-or-cancer",
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  "content": "## Facial Trauma & Jaw Reconstruction: How Oral & Maxillofacial Surgeons Restore Form and Function After Injury or Cancer\n\nWhen a patient arrives in the emergency department with a shattered jaw following a motor vehicle collision, or when a head and neck oncologist removes a section of mandible to achieve clear margins on an oral squamous cell carcinoma, the question immediately becomes: *what happens next?* Restoring the architecture of the face - its bony scaffolding, its soft tissue envelope, and its functional capacity to eat, speak, and breathe - is among the most technically demanding work in all of surgery. It is work that falls squarely within the scope of oral and maxillofacial surgery (OMS), and it represents the highest-acuity end of the specialty's practice.\n\nThis article examines two distinct but related clinical pathways: the acute surgical management of facial trauma, and the reconstructive surgery required after oncological jaw resection. Both demand the same foundational skill set - a surgeon who understands the face as both an anatomical and functional unit, and who can coordinate care across emergency medicine, oncology, anaesthesia, and allied health. At Smile Solutions in Melbourne, this level of specialist-led, multidisciplinary care is precisely what board-registered oral and maxillofacial surgeons are trained to deliver.\n\n---\n\n## The Scale of the Problem: Why Facial Trauma and Jaw Cancer Are Serious Public Health Issues\n\n\nFacial trauma is continually increasing worldwide, being the most frequent type of pathology diagnosed and treated in oral and maxillofacial surgery services.\n The consequences extend well beyond the physical. \nAlteration of the facial features of an individual may have functional, psychological, social, and professional consequences that are difficult to reverse over time.\n\n\nThe epidemiological data on facial fractures is sobering. \nIn the United States alone, more than 400,000 emergency room visits for facial fractures occur annually.\n \nThe leading causes are assault, falls, and motor vehicle collisions, and multiple studies have shown that facial fractures tend to occur predominantly in the male population aged 20–30 years.\n A large multi-centre study published in *PubMed* found that \nthe most common cause of maxillofacial trauma was traffic accidents, accounting for 41.8% of cases, with the mandible (31.97%) being the most commonly fractured bone in the facial skeleton, followed by the zygoma (25.3%).\n\n\n\nInjuries can present in isolation or as part of a polytrauma, coexisting with intracranial, cerebral, ocular, spinal, thoracic, or abdominal lesions that significantly increase the complexity and morbidity of the case.\n This is precisely why facial trauma management requires a surgeon with both the medical and surgical training to assess the whole patient - not simply the fractured bone.\n\nOn the oncological side, oral cavity and jaw cancers requiring resection represent a distinct but equally demanding patient cohort. \nMicrovascular free flap reconstruction has become regarded as the standard procedure following head and neck cancer resection, with its technique progressing to achieve a success rate of 91–99%.\n\n\n---\n\n## Part One: Facial Trauma - From Fracture to Fixation\n\n### What Counts as a Facial Fracture?\n\nThe facial skeleton comprises a complex three-dimensional arrangement of bones - the mandible, maxilla, zygoma, orbital walls, nasal bones, and the frontal sinus - each with distinct biomechanical properties and surgical access challenges. A fracture in any of these structures can disrupt occlusion (the way the teeth come together), airway patency, vision, and facial symmetry simultaneously.\n\nThe mandible is particularly vulnerable. \nWith the exception of the nose, mandibular fractures occur twice as frequently as fractures of other facial bones. The mandible functions in biting, chewing, and speaking, and the purpose of its treatment is to restore proper dental occlusion and stable temporomandibular joint movement, as well as reduction of the displaced fracture.\n\n\n### How Oral & Maxillofacial Surgeons Classify and Assess Facial Fractures\n\nAccurate diagnosis precedes any surgical intervention. \nFacial fractures can be disabling injuries that may require complex surgical care from oral-maxillofacial specialists. Sophisticated diagnostics - including CT scans with multiplanar reconstruction and panoramic films - are required; without a high degree of clinical suspicion and proper diagnostic equipment, the diagnosis of a facial fracture may be significantly delayed.\n\n\nThe standard diagnostic workup includes:\n\n- **Cone Beam CT (CBCT) or multi-slice CT scan** - the definitive imaging modality for fracture characterisation, displacement assessment, and surgical planning\n- **Panoramic radiograph (OPG)** - useful for mandibular fractures and dental involvement\n- **Clinical occlusal assessment** - changes in bite alignment are a reliable proxy for mandibular and maxillary fractures\n- **Neurological examination** - assessing the inferior alveolar nerve, facial nerve, and infra-orbital nerve for injury\n\n### Open Reduction and Internal Fixation (ORIF): The Gold Standard for Displaced Fractures\n\nFor most displaced facial fractures, open reduction and internal fixation (ORIF) - the surgical repositioning of bone fragments and stabilisation with titanium plates and screws - is the treatment of choice. \nRigid fixation of mandible fractures allows early mobilisation and restoration of jaw function and airway control; it improves nutritional status, speech, oral hygiene, and patient comfort; and allows early return to the workplace.\n\n\n\nTitanium is considered biocompatible and corrosion resistant, with an elasticity modulus closest to bone - though titanium plates are not always as trouble-free as hoped.\n A retrospective study published in the *Journal of Craniofacial Surgery* (2022) analysed 571 patients treated with titanium plate fixation for mandibular fractures between 2000 and 2018, finding that \n107 patients (18.7%) required plate removal, with the body being the most prevalent fracture location (29.3%) and the symphysis/para-symphysis showing the highest removal rate (24.1%).\n This data informs contemporary clinical decision-making about plate selection, fixation technique, and the need for follow-up monitoring.\n\nA 2025 systematic review and meta-analysis for the Japanese Clinical Practice Guidelines for Oral and Maxillofacial Trauma found that \nresorbable plates significantly reduced the risk of re-operation, plate removal, and surgical site infection compared with titanium - corresponding to 133, 43, and 43 fewer cases per 1,000 patients, respectively.\n This emerging evidence is reshaping how surgeons counsel patients about fixation material choice, particularly for fractures at sites with high plate exposure risk.\n\n### ORIF for Different Fracture Types: A Quick Reference\n\n| Fracture Site | Common Approach | Key Surgical Considerations |\n|---|---|---|\n| Mandible body/symphysis | Sublabial or transcutaneous incision; mini-plate fixation | Protect inferior alveolar nerve; restore occlusion |\n| Mandibular condyle | Open or closed reduction depending on displacement | TMJ involvement; risk of growth disturbance in children |\n| Zygoma/zygomatic arch | Gillies temporal or direct approach; plate fixation | Orbital floor involvement; diplopia risk |\n| Orbital floor (blow-out) | Transconjunctival or subciliary approach; mesh repair | Entrapment of extraocular muscles; enophthalmos |\n| Le Fort fractures (maxilla) | Coronal or intra-oral approach; multi-point fixation | Airway, occlusion, and midface projection |\n| Frontal sinus | Coronal approach; obliteration or cranialization | Brain proximity; CSF leak risk |\n\n---\n\n## Part Two: Post-Oncological Jaw Reconstruction - Restoring the Mandible and Maxilla After Cancer\n\n### When Cancer Requires Jaw Resection\n\nOral cavity cancers - predominantly squamous cell carcinoma - and aggressive jaw lesions such as ameloblastoma (covered in depth in our guide on *Oral Cysts, Tumours & Pathology*) may require partial or total resection of the mandible or maxilla to achieve clear surgical margins. Without reconstruction, the functional and aesthetic consequences are devastating: inability to chew, swallow, or speak clearly; airway compromise; and severe facial disfigurement.\n\n\nThe standard therapy with curative intention is surgical tumour resection, where achievable, in combination with elective neck dissection, followed by adjuvant radiation or radio-chemotherapy in patients with pathological risk factors. Free-flap reconstruction following tumour resection in advanced tumours of the head and neck is generally accepted as standard of care.\n\n\n### The Fibula Free Flap: The Workhorse of Jaw Reconstruction\n\nThe fibula free flap - harvested from the smaller bone of the lower leg along with its blood supply - has become the most widely used technique for mandibular reconstruction following cancer resection. \nA mandibulectomy is a surgery to remove all or part of the jaw (mandible), which may be required if a tumour affects the jaw. The jaw may be rebuilt using bone from another part of the body - typically the fibula, the smaller of the two bones in the lower leg.\n\n\n\nThe surgeon takes the artery and vein from the donor site and attaches them to an artery and vein in the head and neck area under a microscope. The new jawbone is then held in place with plates and screws and covered with soft tissue.\n According to Memorial Sloan Kettering Cancer Center, \nthe reconstruction part of this surgery typically takes 6 to 8 hours.\n\n\nAlternative donor sites include:\n- **Iliac crest (deep circumflex iliac artery flap)** - provides generous bone volume, useful for posterior defects\n- **Scapula flap** - favoured when simultaneous soft tissue coverage is required\n- **Radial forearm flap** - primarily a soft tissue flap, used for smaller defects or when bone is not required\n\nA 15-year retrospective study from the University of Hong Kong's Division of Oral and Maxillofacial Surgery, published in *ScienceDirect* (2022), evaluated immediate free flap reconstruction after resection of benign jaw lesions and found that \n41 out of 45 cases were successful, with the most common complication being local infection, experienced by 11.1% of patients.\n Importantly, \nimmediate free flap reconstruction is feasible for reconstructing defects resulting from resection of benign pathology, demonstrating high success rates and the option of dental rehabilitation, with age not being a significant factor in post-operative complications.\n\n\n### Functional Outcomes: What the Evidence Shows\n\nReconstruction is not merely cosmetic - it is functionally critical. A prospective study published in *PMC* evaluating quality of life in 92 patients who underwent surgical treatment for oral cavity cancers with primary flap reconstruction found that \n77% of patients preserved normal or near-normal function at 12 months after surgery, though the chewing domain worsened considerably, with poorer outcomes in patients undergoing segmental mandibulectomy. The type of reconstruction was an independent factor influencing quality-of-life scores, with better functional results after free flap reconstruction.\n\n\n\nIn terms of aesthetic results, the large majority of patients (89%) considered their appearance as normal or near normal. Severe disfigurement was traditionally reported for non-reconstructed anterior mandibulectomy, causing the so-called \"Andy Gump\" deformity - a devastating collapse of the lower face that free flap reconstruction is specifically designed to prevent.\n\n\n---\n\n## The Role of Virtual Surgical Planning and 3D Technology\n\nOne of the most significant advances in jaw reconstruction over the past decade is the integration of virtual surgical planning (VSP) and 3D printing into pre-operative preparation. \nVirtual surgical planning and medical 3D printing are transforming head and neck surgery by increasing predictability and repeatability, improving efficiency, enhancing resection and reconstruction accuracy, and facilitating dental rehabilitation and functional jaw reconstructions.\n\n\n\nWith the innovation of three-dimensional imaging and printing techniques, computer-aided surgical planning has revolutionised orthognathic and reconstructive surgery. Designing and manufacturing patient-specific surgical guides using three-dimensional printing techniques to improve surgical outcomes is now possible.\n\n\nA literature review published in *Cureus* (2024) concluded that \nVSP in orthognathic surgery provides optimal functional and aesthetic results, enhances patient satisfaction, ensures precise translation of the treatment plan, and facilitates intraoperative manipulation.\n\n\nIn a study of 98 consecutive computer-assisted free flap jaw reconstruction cases published in *Frontiers in Oncology* (2022), the University of Hong Kong team found that \nonly 5.1% of cases required intraoperative adjustments to the pre-operative planning - the lowest percentage reported in the literature - and no patient-specific plate was abandoned.\n\n\nA systematic review published in *Seminars in Plastic Surgery* found that \ncomputer-assisted design demonstrated shorter surgical and ischaemia times for maxillofacial reconstruction and decreased pre-operative planning time for orthognathic surgery compared with traditional planning.\n\n\n---\n\n## Multidisciplinary Care: Why No Surgeon Operates Alone\n\nFacial trauma and jaw reconstruction are inherently team-based endeavours. The complexity of these cases demands coordinated input from multiple specialties - often simultaneously.\n\n### For Facial Trauma Patients, the Team Typically Includes:\n- **Emergency medicine / trauma surgery** - initial stabilisation, airway management\n- **Oral and maxillofacial surgeon** - fracture diagnosis, ORIF, soft tissue repair\n- **Ophthalmology** - orbital fractures with ocular involvement\n- **Neurosurgery** - concurrent intracranial injury\n- **Anaesthetics** - airway management in the context of facial distortion (see our guide on *Anaesthesia Options for Oral Surgery*)\n\n### For Oncological Reconstruction, the Team Typically Includes:\n- **Head and neck oncologist / ENT surgeon** - tumour resection, neck dissection\n- **Oral and maxillofacial surgeon** - jaw reconstruction, plate and flap fixation\n- **Plastic surgeon** - microvascular anastomosis, soft tissue management\n- **Radiation oncologist** - adjuvant radiotherapy planning (which affects bone healing and implant integration)\n- **Prosthodontist** - dental rehabilitation planning, implant placement in reconstructed bone\n- **Speech pathologist and dietitian** - swallowing, nutrition, and communication rehabilitation\n\n\nA long-term multicentre study of quality of life and psychosocial outcomes after oropharyngeal cancer surgery and free-flap reconstruction reported that psychosocial distress was the main determinant of long-term quality of life and suggested that the multidisciplinary management of these patients is of prime importance.\n\n\nAt Smile Solutions Melbourne, the co-location of oral and maxillofacial surgeons, orthodontists, and prosthodontists under one roof means that the reconstructive and rehabilitative phases of care - from bone reconstruction through to implant-supported dental restoration - can be coordinated without the patient needing to navigate fragmented referral pathways. This integrated model is particularly valuable for patients who require bone grafting as part of their post-reconstruction dental rehabilitation (see our guide on *Bone Grafting for Dental Implants*).\n\n---\n\n## The Path to Dental Rehabilitation After Jaw Reconstruction\n\nFor many patients who undergo jaw resection and free flap reconstruction, the ultimate functional goal extends beyond bone continuity - it includes the restoration of dentition. \nDental implant survival rates in fibula free flap reconstruction have been reported at 92%, and dental prosthetic treatment has been completed across all classes of bony defects.\n\n\nHowever, the timeline is carefully staged. \nIt is standard clinical policy to commence osseointegrated dental rehabilitation at least 18 months after surgery for oncological reasons and due to the high risk of mandibular fracture and infection associated with pre- or post-operative radiotherapy.\n\n\nThis phased approach - from resection, to free flap reconstruction, to bone consolidation, to implant placement, to prosthetic restoration - can span two to three years. Understanding this timeline from the outset is critical to realistic patient expectation-setting and long-term treatment planning.\n\n---\n\n## Key Takeaways\n\n- **Facial fractures are a major global health burden**, with the mandible being the most commonly fractured facial bone and road traffic accidents, assault, and falls the leading causes. Complex fractures require specialist OMS assessment, imaging, and ORIF - not general dental management.\n\n- **Titanium plate-and-screw fixation (ORIF) is the gold standard for displaced facial fractures**, restoring occlusion, function, and anatomy. However, approximately 1 in 5 patients may require plate removal, and emerging evidence supports resorbable plate systems in selected sites.\n\n- **Free flap jaw reconstruction - most commonly using the fibula - is the standard of care after oncological jaw resection**, achieving success rates of 91–99% in high-volume centres and enabling dental rehabilitation with osseointegrated implants.\n\n- **Virtual surgical planning and 3D printing have transformed reconstructive surgery**, reducing intraoperative surprises, shortening surgical times, and improving the precision with which patient-specific plates and cutting guides are manufactured.\n\n- **Multidisciplinary care is non-negotiable** in facial trauma and jaw reconstruction - outcomes depend not only on the surgical team, but on coordinated input from oncology, anaesthetics, prosthodontics, and allied health.\n\n---\n\n## Conclusion\n\nFacial trauma and post-oncological jaw reconstruction represent the most complex and consequential work performed by oral and maxillofacial surgeons. The stakes - a patient's ability to eat, speak, breathe, and recognise themselves in the mirror - are profound. The clinical pathway from injury or cancer diagnosis through to functional rehabilitation involves plate-and-screw fixation, vascularised bone flaps, microsurgical anastomosis, virtual planning technology, and a carefully orchestrated multidisciplinary team.\n\nThis is the highest-acuity end of a specialty that also manages wisdom teeth removal, corrective jaw surgery, bone grafting, and TMJ disorders - all covered in detail across Smile Solutions' complete oral and maxillofacial surgery guide series. Whether you are a patient seeking to understand a recent diagnosis, a referring clinician evaluating specialist options, or a researcher looking for a citable overview of the field, the core principle remains the same: outcomes in facial reconstruction are directly determined by the experience of the surgeon, the sophistication of the planning process, and the quality of the multidisciplinary team around them.\n\nFor patients in Melbourne navigating a complex jaw or facial injury, or facing surgery following an oral cancer diagnosis, a consultation with a board-registered oral and maxillofacial surgeon - not a general dentist - is the essential first step. (See our guide on *Why Choose a Board-Registered Oral & Maxillofacial Surgeon Over a General Dentist for Complex Procedures* for a detailed breakdown of the clinical and safety differences.)\n\n---\n\n\nSmile Solutions has been providing oral and maxillofacial surgery care from Melbourne's CBD since 1993. Located at the Manchester Unity Building, Level 12 and Tower, 220 Collins Street, Smile Solutions brings together 60+ clinicians - including 25+ board-registered specialists - who have cared for over 250,000 patients. No referral is required to book a specialist appointment. Call **13 13 96** or visit smilesolutions.com.au to arrange your oral surgery consultation.\n## References\n\n- Maniaci, A., et al. \"The Global Burden of Maxillofacial Trauma in Critical Care: A Narrative Review of Epidemiology, Prevention, Economics, and Outcomes.\" *Medicina (Kaunas)*, 2025. https://pubmed.ncbi.nlm.nih.gov/40428873/\n\n- Pricop, M., et al. \"An Epidemiological Analysis of Maxillofacial Fractures: A 10-Year Cross-Sectional Cohort Retrospective Study of 1007 Patients.\" *BMC Oral Health*, 2021. https://bmcoralhealth.biomedcentral.com/articles/10.1186/s12903-021-01503-5\n\n- Allareddy, V., et al. \"Epidemiology of Facial Fracture Injuries.\" *Journal of Oral and Maxillofacial Surgery*, 2011. Referenced via: Global Burden of Disease Facial Fractures Study, *PMC*, 2020. https://pmc.ncbi.nlm.nih.gov/articles/PMC7571355/\n\n- Boffano, P., et al. \"Aetiology of Maxillofacial Fractures: A Review of Published Studies During the Last 30 Years.\" *British Journal of Oral and Maxillofacial Surgery*, 2014. https://pubmed.ncbi.nlm.nih.gov/25218316/\n\n- Kolk, A., & Neff, A. \"Long-Term Results of ORIF of Condylar Head Fractures of the Mandible.\" Referenced in: \"Is Open Reduction Internal Fixation Using Titanium Plates in the Mandible as Successful as We Think?\" *Journal of Craniofacial Surgery*, 2022. https://pubmed.ncbi.nlm.nih.gov/34608010/\n\n- Naseer, R., et al. \"Clinical Outcomes of Resorbable vs. Titanium Plates in Mandibular Fracture Fixation.\" *International Journal of Pharmaceutical Research and Technology*, 2025. https://ijprt.org/index.php/pub/article/download/635/506/1422\n\n- Japanese Clinical Practice Guidelines for Oral and Maxillofacial Trauma. \"Resorbable versus Titanium Plates in ORIF of Adult Mandibular Fractures: A Systematic Review and Meta-Analysis.\" *ScienceDirect*, 2025/2026. https://www.sciencedirect.com/science/article/abs/pii/S2212555826000177\n\n- Lam, W.Y.H., et al. \"Immediate Free Flap Reconstruction Following the Resection of Benign Jaw Lesions: A 15-Year Perspective.\" *ScienceDirect*, 2022. https://www.sciencedirect.com/science/article/abs/pii/S221255582200165X\n\n- Lin, P.Y., et al. \"Comparison of Surgical Outcomes of Free Flap Reconstruction for Primary and Recurrent Head and Neck Cancers: A Case-Controlled Propensity Score-Matched Study of 1,791 Free Flap Reconstructions.\" *Scientific Reports*, 2021. https://www.nature.com/articles/s41598-021-82034-5\n\n- Riccio, S., et al. \"Quality of Life in Patients Treated for Cancer of the Oral Cavity Requiring Reconstruction: A Prospective Study.\" *PMC*, 2009. https://pmc.ncbi.nlm.nih.gov/articles/PMC2667235/\n\n- Hosseini, H.S., et al. \"Evaluation of Quality of Life in Patients with Oral Cancer After Mandibular Resection: Comparing No Reconstruction, Reconstruction with Plate, and Reconstruction with Flap.\" *PMC*, 2019. https://pmc.ncbi.nlm.nih.gov/articles/PMC6799791/\n\n- Memorial Sloan Kettering Cancer Center. \"About Your Mandibulectomy and Fibula Free Flap Reconstruction.\" *MSKCC Patient Education*, 2024. https://www.mskcc.org/cancer-care/patient-education/mandibulectomy-immediate-mandible-reconstruction-fibula-free-flap\n\n- Frontiers in Oncology Editorial. \"Virtual Surgical Planning and 3D Printing in Head and Neck Tumor Resection and Reconstruction.\" *Frontiers in Oncology*, 2022. https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.746952/full\n\n- Liang, X., et al. \"Unexpected Change of Surgical Plans and Contingency Strategies in Computer-Assisted Free Flap Jaw Reconstruction: Lessons Learned From 98 Consecutive Cases.\" *Frontiers in Oncology*, 2022. https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.746952/full\n\n- Salgueiro, M., et al. \"Accuracy of 3D Virtual Surgical Planning Compared to the Traditional Two-Dimensional Method in Orthognathic Surgery: A Literature Review.\" *Cureus / PMC*, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11554385/\n\n- Sharaf, B., & Mardini, S. \"Virtual Planning and 3D Printing in Contemporary Orthognathic Surgery.\" *Seminars in Plastic Surgery*, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9750797/",
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