Counting the cost of facial trauma

DOES it seem fair that a person who starts a drunken pub brawl and is injured in the process will undergo a facial surgery within days and ultimately extend the waiting time of an elderly person awaiting a knee reconstruction?

A facial surgeon says trauma to people's faces from violent attacks has a negative impact on hospital waiting lists and the health system.

Wesley Hospital oral and maxillofacial specialist surgeon  John Arvier said face trauma needed to be fixed quickly to prevent long-term damage, which is why these patients were often seen quickly.

But he said this affected hospital waiting lists.

Dr Arvier is responsible for fixing patients' faces that have been damaged in some way including in violent attacks.

While he said the number of patients he saw with facial trauma had decreased, the extent of injuries was worsening.

"One thing we tend to see more often is more major damage," he said.

Dr Arvier said in the "old days" blokes would throw a few punches and that would be the end of it. He said now more people were using weapons and causing more serious injuries.

Most facial fractures require some sort of surgery where bones are put back into place and supported with a titanium plate or screw.

"Titanium is a very good metal," Dr Arvier said. "It doesn't set off metal detectors and allergic reactions are rare. It is a great way of repairing a fracture."

Dr Arvier said fixing a person's face was not like stitching up cuts on an arm or plastering someone's leg.

Facial injuries can also have longer lasting effects, especially when there is scarring.

"You have to be aware of getting as close and correct as possible," he said.

"Most (stitches) can be hidden in natural skin creases or around the jaw... and a lot can be placed inside the mouth.

"But the face tends to heal well in the long run."

With facial injuries, swelling lasts for about a week or two and fractures take about six weeks to heal.

Dr Arvier said during this time patients could not chew steak, play any sports or do any heavy lifting.

On a positive note, he said most facial work was conducted on younger, fitter and healthy people who could bounce back from injuries better than more elderly people.

Some people are never the same after violence

WHILE most people can recover from a violent attack over time, there are some who will never be physically and mentally the same.

Oral and maxillofacial specialist surgeon Dr John Arvier said a person's face was one of the most important parts of the body; it identified a person's individuality and was their source of expressing emotions.

He said this could be why the face was often targeted in violent attacks.

He said most patients, especially those who were young and healthy, recovered quickly from facial surgeries.

"But there is a small percentage who are left with an obvious scar that can't be hidden, caused by the trauma," Dr Arvier said.

If nerves are damaged, an assault victim may not be able to smile symmetrically or the lip may droop a bit.

"Those people are very upset (because of the) long term."

Clinical, health and forensic psychologist Dr Bob Montgomery said about 80% of victims would mentally recover from an assault with basic support, including counselling and from friends and family.

But there are the other 20% who develop serious problems including anxiety, anger and an increase in use of alcohol or drugs.

Dr Arvier said being assaulted did not always influence a person's mental health in the long term.

He said most of the time his patients were up front about what happened to cause the assault and admitted if they were in the wrong.

"Some of them know they got themselves drunk and put themselves in that situation where they were going to be in harm's way," he said.


What it's like to have:

Mid-face trauma:

- Swelling and bruising around the eye

- Blurry vision

- Numbness in cheek

- Clear watery fluid draining from nose

- Sunken appearance to the eyeball

Sinus bones fracture:

- Severe swelling

- Bruising around eye

Jawbone and nose fractures:

- Inability to bring teeth together

- Bruising under tongue

- Numbness

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