Management of Traumatic Soft Tissue Injuries of the Face

Abstract

Facial soft tissue injuries encompass a broad spectrum of presentations and often present significant challenges to the craniofacial surgeon. A thorough and systematic approach to these patients is critical to ensure that the patient is stabilized, other injuries identified, and the full extent of the injuries are assessed. Initial management focuses on wound cleaning with irrigation, hemostasis, and debridement of nonviable tissue. Definitive management is dependent on the region of the face involved with special considerations for critical structures such as the globe, lacrimal apparatus, facial nerve, and parotid duct. Following sound surgical principles, these injuries can be managed to maximize both functional and aesthetic outcomes while minimizing complications.

Keywords: facial nerve; facial trauma; laceration; parotid duct; soft tissue injury.

Fig. 1

Traumatic tattooing of the right cheek from embedding of particulate matter (in this case asphalt) into an open soft tissue injury.

Fig. 2

Upper lid Lagophthalmos following left upper eyelid laceration repair with deepening of left upper eyelid fold with the eye open (left) and medial lagophthalmos with eye closure (right) due to tethering of the upper eyelid to the orbital septum.

Fig. 3

A significant soft tissue and cartilage amputation from bilateral ears following a dog attack (left, center). The amputated parts were available (right) but given the mechanism and extent of the injury with no identifiable blood vessels for replantation, the decision was made to stabilize the soft tissues and plan for a staged reconstruction.

Fig. 4

Initial midface soft tissue injury requiring operative exploration and zygomaticobuccal nerve repair (left), immediate post-operative facial function with right midface weakness (middle), and 8 month post-operative photograph (right) with improvement of facial function.