Skull and Face Fractures

Symptoms

• Pain and tenderness: Focused pain, tenderness, or a step-off you can feel at the injured bone.
• Swelling and bruising: Rapid swelling or bruising, including bruising around both eyes or behind the ear.
• Facial deformity: A flattened cheek, crooked nose, sunken eye, or teeth that no longer meet correctly.
• Double or blurred vision: Trouble moving the eye or double vision, which can signal an eye-socket fracture.
• Numbness: Numbness of the cheek, upper lip, gums, or forehead from injury to facial nerves.
• Bleeding or clear drainage: Nosebleed, bleeding from the ear, or thin clear fluid draining from the nose or ear.
• Head-injury signs: Headache, confusion, drowsiness, nausea, or vomiting suggesting a possible concussion or brain injury.

When It's an Emergency

Call 911 immediately for any head or face injury with loss of consciousness, repeated vomiting, a seizure, worsening confusion or drowsiness, weakness or numbness on one side, unequal pupils, or a severe or worsening headache. These can be signs of bleeding or swelling in the brain, which is a life-threatening emergency.

Go to the ER right away, or call 911 if you cannot travel safely, for thin clear fluid draining from the nose or ears, bruising around both eyes or behind the ear, a visibly deformed or unstable face, a nosebleed you cannot control, or any injury to the eye or vision.

Seek emergency care for facial injuries that affect breathing or swallowing, cause the jaw or teeth to no longer line up, or come with heavy bleeding. High-energy injuries such as car crashes, assaults, and falls from a height carry a higher risk of serious fracture and hidden brain injury and should be evaluated in an ER.

Because skull and facial fractures so often overlap with head injury, when in doubt it is safer to be checked. Blood thinners, older age, and a bleeding disorder raise the risk and lower the threshold for going in.

Bellaire ER evaluates and stabilizes skull and facial injuries 24/7 with on-site CT and X-ray, and arranges rapid hospital transfer when neurosurgical or specialist repair is required.

When It's Not an Emergency

A very minor, isolated facial injury with no fracture signs may be reasonable to watch at home or discuss by telemedicine first. Examples include a small nose bump with no deformity and normal breathing, mild swelling that improves with ice, or a superficial bruise or scrape with no other symptoms.

Telemedicine or a primary care or dental visit can be appropriate for lingering questions after a known minor injury, such as a small chip in a tooth, mild jaw soreness with a normal bite, or follow-up on a previously evaluated injury.

If you are unsure, or if pain, swelling, or vision changes worsen over the following hours, get an in-person exam. Telemedicine cannot perform the CT or X-ray imaging needed to rule out a fracture or bleeding, so any real concern for a broken bone belongs in the ER.

What Happens at Bellaire ER

At Bellaire ER you are seen quickly by a board-certified emergency physician who examines the injured area, checks your vision, eye movements, facial sensation, bite, and airway, and screens for signs of brain injury. We assess how the injury happened to gauge the risk of a serious fracture.

We have CT and X-ray on-site. CT is the main test for skull and facial fractures and also shows bleeding around the brain; X-ray and our on-site lab support the workup as needed, so there is no wait to travel elsewhere for imaging.

Many stable, isolated fractures are managed with pain control, ice, wound care, and specialist follow-up with ear-nose-throat, oral-maxillofacial, plastic surgery, or ophthalmology. We handle diagnosis and initial treatment in a single visit, and most patients do not need a hospital transfer.

If imaging shows bleeding in the brain, an open or complex fracture, an unstable airway, or an injury that needs an operation, we stabilize you and arrange rapid transfer to the appropriate specialty or trauma service.

Prevention

Wear a seat belt and keep airbags in service, and use a properly fitted helmet for cycling, contact sports, skating, and motorcycles. Use a mouthguard and face protection for high-contact sports.

Reduce fall risk at home by improving lighting, removing loose rugs and clutter, using grab bars and non-slip mats in the bathroom, and having vision checked regularly, which matters most for older adults and young children.