Management of Traumatic Soft Tissue Injuries of the Face

Min

et al. 2023

Preprint

Background Surgical debridement is usually an essential step in treating complex facial lacerations (CFL). As the severity of CFL increases, conventional surgical debridement (CSD) of wound edges becomes difficult and may be insufficient to remove damaged tissues and create clean edges. Because the severity and shape of CFL are diverse and different, it is necessary to tailor the customized pre-excisional design, the tailored surgical debridement (TSD), for each case before performing surgical debridement. Applying TSD is expected to enable effective debridement in CFL with higher severity. This study compared cosmetic outcomes and complication incidence of CSD and TSD, according to CFL severity. Methods This was a retrospective observational study. Eligible patients with CFL who visited the emergency department between August 2020 and December 2021 were examined. CFL severity was graded to Grades I and II. CSD and TSD outcomes were compared using the Scar Cosmesis Assessment and Rating (SCAR) scale. Furthermore, a good cosmetic outcome was defined as a SCAR score of ≤ 2. The percentage of good cosmetic outcome between the two groups was compared. The SCAR score and percentage of good cosmetic outcomes between the two groups were compared overall and by severity. For comparison of complication incidence, asymmetry, infection, and dehiscence incidence were compared. Results In total, 252 patients were enrolled (121 [48.0%] CSD and 131 [52.0%] TSD). In CSD and TSD groups, the median SCAR scores were 3 (1–5) and 1 (0–2) in all enrolled patients (p < 0.001), 2 (0–4) and 1 (0–1) in Grade I (p < 0.01), and 5 (4–6) and 1 (1–2) in Grade II (p < 0.001). The good cosmetic outcomes were 46.3% and 84.0% overall (p < 0.001), 59.6% and 85.0% in Grade I (p < 0.01), and 9.4% and 83.5% in Grade II (p < 0.001) for CSD and TSD. The incidence of complications was significantly higher in the CSD than in the TSD groups, but this was limited to asymmetry. There was no statistical difference in both infection and dehiscence. Conclusion TSD can lead to an objectively good cosmetic prognosis at higher CFL severity than CSD and can reduce the occurrence of facial asymmetry.

“…In correcting damage through debridement, excessive tension, gaping, and facial asymmetry may occur [5,[12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Tailored versus conventional surgical debridement in complex facial lacerations: a retrospective study

Min

et al. 2023

Preprint

“…Debridement of dead tissue must be done conservatively to retain sufficient tissue for repair. 11 Direct pressure is the primary method of stopping bleeding and identifying occluded blood vessels. Seen Wound closure with sutures should be done optimally as soon as the patient is stable.…”

Section: Discussionmentioning

confidence: 99%

“…Landmarks include the philtrum, cupid's bow, oral commissure, and the vermilion cutaneous border, which are the most important landmarks. 11 Wet and dry lips require different suture materials. Wet lips require absorbable sutures such as 4-0 or 5-0 chromic and vicryl versus non-dissolvable, 5-0 or 6-0 prolene for dry lips.…”

Section: Discussionmentioning

confidence: 99%

Emergency Management of Maxillofacial Soft Tissue Wounds due to Physical Trauma

Septian

Sundari²,

Sjamsudin³

et al. 2023

IJMBS

Introduction: Soft tissue trauma is common in the head and neck, limited to superficial structures or involving deeper anatomical structures. Various types of trauma occur depending on the aetiology and mechanism. Managing oral and maxillofacial soft tissue trauma poses a challenge for surgeons due to the importance of facial esthetics. The purpose of this case report is to report and discuss the emergency management of soft tissue injuries in the maxillofacial region due to physical trauma. Case report: Three cases with diagnoses of abrasive wounds, lacerations, and punctum wounds on the lips, cheeks, eyebrows, chin, and oral cavity were encountered at the emergency department of Hasan Sadikin Hospital, Bandung City, due to a motor accident. Treatment includes debridement, reconstruction, and wound closure. Conclusion: Emergency treatment of soft tissue wounds in the maxillofacial area that is fast and according to the procedure will reduce infection and dehiscence. Keywords: emergency, soft tissue injury, Maxillofacial, Physical trauma

“…The anesthesia of this nerve rst requires the location of the foramen through which it emerges on the face. During loco-regional anesthesia by block of the infra orbital nerve, the surgeon must locate himself by palpating the lower edge of the orbital oor to identify the infra orbital foramen, then insert the needle upwards to in ltrate a local anesthetic [3]. A traumatic section of the infraorbital vascular-nervous bundle can occur during facial surgery or dental implantology, thus causing a disturbance in the sensitivity of the face and or more or less signi cant bleeding in this region [4].…”

Section: Introductionmentioning

confidence: 99%

Assessment of infraorbital foramen position using CT-Scan in a cohort of Cameroonian adults : landmarks in facial surgery and anesthesiology

Akaba

Ebogo

Amougou

et al. 2022

Preprint

Backgroung: the infraorbital foramen (IOF) is a hole located in the maxillary bone and delivering passage to the infra orbital vascular-nervous bundle. It is an essential structure in the management of orofacial pathologies. Its precise location allows optimal anesthesia of the infraorbital nerve during cleft lip and palate surgery or alcoholization during the management of essential V2 neuralgia. The aim of our research was to determine the morphology and morphometry of the infraorbital foramen in a sample of the Cameroonian population. Methods: we included 208 CT-Scans of patients meeting our search criteria. We determined the shape of the IOF and evaluated the transverse and vertical diameters of the IOF. We assessed the distance of the IOF from the maxillary alveolar crest, the lateral border of the piriform aperture and the infraorbital margin. The Student test was used to determine the association between different variables. the P-value of 0.05 was considered significant and the confidence interval was 95%. Results: The mean transverse diameter of the left IOF was 1.97 mm ± 0.51 while 1.78 mm ± 0.53. The IOF was more often medial to the lateral palpebral commissure- nasal wing line on the left and right (78.8% and 72.6%, respectively). Our sample showed that in 35.6% (n=94) of subjects, the IOF was round on the left, whereas it was round in 45.2% (n=94) of patients. Conclusion: the position of the IOF is of particular interest in the management of facial pathologies. Knowing its location makes it possible to avoid a section of the infraorbital neurovascular bundle that can cause sometimes irreversible sequelae.