Facial Soft Tissue Trauma

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This article focuses on facial soft tissue trauma. No other part of the body is as conspicuous, unique, or aesthetically significant as the face. Because an individual’s self-image and self-esteem are often derived from his or her own facial appearance, any injury affecting these features requires particular attention.

Patients with traumatic facial injuries often present with extremely disfigured appearances. Such injuries may distract receiving physicians from other potentially life-threatening injuries such as closed head trauma or cervical spine injuries that can be associated with severe facial trauma. Each patient who presents with significant traumatic facial injuries should be treated in accordance with American Trauma Life Support (ATLS) protocols.

Once immediately life-threatening issues such as airway compromise and uncontrolled bleeding have been addressed, other multisystem trauma is excluded. Attention can then be turned to defining and definitively treating the patient’s facial injuries.

Historically, severe facial trauma often resulted in cosmetic and functional defects; however, advances in the science of reconstructive surgery and in the management of trauma patients have significantly improved the morbidity associated with facial traumatic injuries. In the most extreme cases, facial transplantation has even been accomplished at a number of centers throughout the world. ^{[1, 2]}

In the United States, motor vehicle accidents (MVAs) were the most frequent cause of facial injuries before 1970. Since then, with the institution of state seat belt laws, the number of deaths from MVAs has declined, and so has the incidence of facial injuries. However, the prevalence of facial trauma has remained fairly constant. This steady prevalence is attributable to the growing population and to other human factors, such as on-the-job accidents, sports-related injuries, domestic interpersonal violence, self-inflicted wounds, and animal bites. ^{[3, 4, 5, 6, 7]}

The mechanism of injury for facial trauma varies widely from one locality to the next, depending significantly on the degree of urbanization, the socioeconomic status of the population, and the cultural background of each region. In rural areas, MVAs continue to be a primary contributor to significant facial injuries. In inner metropolitan areas, however, domestic violence is the leading cause of facial trauma despite a denser population, a difference that may be due to stricter enforcement of traffic laws.

In the United States, approximately 3 million people present to emergency departments (EDs) for treatment of traumatic facial injuries each year. Most of these injuries are relatively minor soft tissue injuries that simply require first-aid care or primary closures.

The exact frequency of facial soft tissue injuries related to sports participation is unknown. This is, in part, due to the minor nature of many injuries, which can lead to underreporting; it may also be due to the wide variation that is seen between demographic groups and between specific sports.

Previous reports estimate sports participation to account for 3-29% of all facial injuries. ^[8] In terms of overall sports-related injury, facial trauma accounts for 11-40% of injuries attended to by medical professionals. Most injuries are reported in males, particularly those aged 10-29 years. Sports that mandate the use of helmets and face masks tend to be associated with fewer soft tissue injuries than sports that do not mandate the use of such equipment.

Using the National Electronic Injury Surveillance System, a study by Bobian et al determined that among 109,795 nursing home residents aged 60 years or older who, between January 1, 2011, and December 31, 2015, suffered facial trauma requiring emergency department care, lacerations (48,679 persons, or 44.3%) and other soft tissue trauma (45,911 persons, or 41.8%) were most common. ^[9]

The prognosis for most facial soft tissue injuries is good; the injuries usually heal rapidly, allowing the patient to return to usual activities, including sports. Knowing the expectations of the patient and the patient’s family is important to ensure that the treatment result is optimal.

Facial soft-tissue injury complications include, but are not limited to, infection, hematoma, flap or wound-edge necrosis, nasal septum necrosis, parotid duct laceration, retained foreign body, poor cosmesis and permanent deformity (eg, cauliflower ear), and loss of function related to nerve injury or scarring.

Proper home wound care should be clearly explained to the patient and his or her family.

For patient education resources, see the Eye and Vision Center, as well as Black Eye and Eye Injuries.

Gordon CR, Siemionow M, Papay F, et al. The world’s experience with facial transplantation: what have we learned thus far?. Ann Plast Surg. 2009 Nov. 63(5):572-8. [Medline].

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Sitzman TJ, Hanson SE, Alsheik NH, Gentry LR, Doyle JF, Gutowski KA. Clinical criteria for obtaining maxillofacial computed tomographic scans in trauma patients. Plast Reconstr Surg. 2011 Mar. 127(3):1270-8. [Medline].

Goodstein WA, Stryker A, Weiner LJ. Primary treatment of shotgun injuries to the face. J Trauma. 1979 Dec. 19(12):961-4. [Medline].

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Toure G, Angoulangouli G, Meningaud JP. Epidemiology and classification of dog bite injuries to the face: a prospective study of 108 patients. J Plast Reconstr Aesthet Surg. 2015 May. 68 (5):654-8. [Medline].

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Tan E, Mortimer N, Salmon P. Full-thickness skin grafts for surgical defects of the nasal ala – a comprehensive review, approach and outcomes of 186 cases over 9 years. Br J Dermatol. 2014 May. 170 (5):1106-13. [Medline].

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Daniel D Sutphin, MD, FACS Attending Plastic and Reconstructive Surgeon, Yuma Regional Medical Center

Daniel D Sutphin, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Steve Lee, MD Physician in Plastic, Reconstructive, and Hand Surgery, Plastic Surgery, PLLC

Steve Lee, MD is a member of the following medical societies: American College of Surgeons, American Society of Plastic Surgeons

Disclosure: Nothing to disclose.

Yelena Bogdan Stony Brook University Health Sciences Center School of Medicine (SUNY)

Yelena Bogdan is a member of the following medical societies: Phi Beta Kappa

Disclosure: Nothing to disclose.

Armand R Lucas, MD 

Armand R Lucas, MD is a member of the following medical societies: American Society for Aesthetic Plastic Surgery

Disclosure: Nothing to disclose.

Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;The Physicians Edge;Sync-n-Scale;mCharts<br/>Received income in an amount equal to or greater than $250 from: The Physicians Edge, Cliexa<br/> Received stock from RxRevu; Received ownership interest from Cerescan for consulting; .

Dominique Dorion, MD, MSc, FRCSC, FACS Vice Dean and Associate Dean of Resources, Professor of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Sherbrooke Faculty of Medicine, Canada

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Terance (Terry) Ted Tsue, MD Vice-Chairman for Administrative Affairs, Professor, Residency Program Director, Department of Otolaryngology-Head and Neck Surgery, University of Kansas School of Medicine

Terance (Terry) Ted Tsue, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Medical Association, American Society for Head and Neck Surgery, Association for Research in Otolaryngology, Johns Hopkins Medical and Surgical Association, Missouri State Medical Association, Phi Beta Kappa, and Society of University Otolaryngologists-Head and Neck Surgeons

Disclosure: Nothing to disclose.

Facial Soft Tissue Trauma

Research & References of Facial Soft Tissue Trauma|A&C Accounting And Tax Services
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