Facial Lacerations Research Articles

Clinical Experience in Emergency Management of Severe Facial Trauma.

Published reports describing management of complex facial lacerations in the emergency department are limited, and there is little guidance on the treatment of massive soft tissue avulsions of the head and face or severely contaminated head and face lacerations. Here, the authors report on the wealth of clinical experience they have gained in treating major head and facial injuries through an emergency trauma repair platform that was established in the department of orthopedic surgery at their hospital. Six patients with massive soft tissue avulsions of the head and face caused by trauma were treated in our department between September 2017 and December 2018. Avulsion injuries occurred to the eyelids, ears, face, and part of the scalp. Defects extended from the skin to the surface of the bone. Emergency surgical repair involved reasonable debridement of the wound surface, accurate and meticulous suture, and use of local skin flaps. No patients experienced postoperative complications, such as necrosis, infection, or scar hyperplasia. Our postoperative satisfaction survey showed that 3 patients were very satisfied and 1 patient was relatively satisfied with their outcomes. Several patients (2/6) still had some degree of deformity in the soft tissue around the eyes, which required further surgery CONCLUSION:: Satisfactory functional and aesthetic outcomes can be achieved through reasonable debridement of the wound surface, accurate and meticulous suture, and use of local skin flaps in patients with massive soft tissue avulsions of the head and face caused by trauma.

Variations in the aftercare of facial wounds: a survey of maxillofacial clinicians.

Good aftercare of traumatic wounds reduces the risk of infection and improves functional and aesthetic outcomes. Inconsistencies in the instructions given by oral and maxillofacial (OMF) surgeons to patients with facial lacerations have previously been noted. We therefore sent anonymous online surveys to OMF clinicians in the United Kingdom to investigate the extent of the variation in aftercare advice given to patients who have had traumatic lacerations of the skin of the head and neck. Respondents were asked about their current practice, including instructions on how to clean wounds, the provision of cleaning materials, use of topical dressings, and advice regarding dry time; also the number of days before the removal of sutures, and specialist review of facial wounds. A total of 63 responded. There was considerable variation within and between grades regarding the advice given. Advice varied and there was no consensus in any of the areas questioned. Robust evidence on the aftercare of traumatic lacerations is lacking. To develop practical guidelines for advice there is a need for further research in the area and further discussion about the aftercare of lacerations.

A descriptive study of facial lacerations presenting to pediatric emergency in Turkey.

Soft tissue trauma of the face is considered a leading cause of presentation and referral to the pediatric emergency department. The present study aims to evaluate the demographics properties of facial injuries presenting to the pediatric emergency. In this study, 1160 patients presented with a simple facial laceration to the pediatric emergency department of Başkent University were reviewed from 2011 to 2017. Patients up to 18 years of age were included. We evaluated demographics about patients' age, sex, the cause of injury, the location of laceration and timing of the injury. Age was categorized according to the National Institute of Child Health and Human Development (NICHD) pediatric terminology into five groups as follows: 0-12 months, 12 months-2 years, 2-5 year, 6-11 year, and 12-18 years. The following analyses were performed to each age group: a number of cases, male to female predominance, timing of injury (e.g., early morning, afternoon, evening, late evening and at night), the place that the injury has occurred (e.g., at home, at school, in sport hall), the cause of injury (fall, hitting a hard subject, sports-related), the location of laceration (forehead, periorbital area, cheek, perioral area, nose, submental area) and the incidence according to the season. Number and relative percentages of cases were as follows: 0-12 months (n=127, 10.9%), 12-24 months (n=113, 9.7%), 3-5 years (n=385, 33.1%), 6-11 years (n=403, 34.7%) and 12-17 years (n=132, 11.3%). The average age of children was 6.5 year (range, 5 month - 17.9 year). The age group 6-11 showed a higher incidence compared to other age groups (n=403, 34.7%). Fifty-three percent of the population was younger than six years and there was a male predominance in all age groups. The demographic data provided in this study can be useful in trauma prevention programs which are effective in reducing the incidence, nature and severity of facial lacerations. Parents should be reminded of age-specific preventive measures in injury avoidance.

Spectrum of Ocular Injuries and Visual Outcome Following Firework Injury to the Eye.

Background:Ocular injury due to fireworks requires urgent ophthalmic assessment and management to preserve vision.Methods:Spectrum of injury, type of intervention, visual outcome, and reasons for visual loss were assessed in consecutive patients presenting over 2 years with firework-related eye injury. The final visual outcome was recorded as best-corrected visual acuity.Results:In the 96 patients (75 males) enrolled, 122 eyes were involved. Twenty-six patients had bilateral eye injury. The median (interquartile) age was 14 (8, 28.5) years. Injuries occurred during Diwali festival (59.4%) and funeral processions (20.8%); over half (53.8%) were bystanders. Injury was due to negligence (78%), device malfunction (12.5%), and attempts to reignite (5.2%) or recover failed device (4.2%). Presenting symptoms were redness (100%), pain (97%), watering (86%), and reduced vision (77%). Facial laceration, contusion, or hematoma occurred in 13 patients. The most frequent adnexal and ocular surface injuries were lid burns (57.3%), edema (44.2%), charred eyelashes (24.6%), and laceration (13.9%). Open-globe injury occurred in 8 eyes. Common anterior segment injuries were corneal epithelial defect (51.6%) and hyphema (20.5%). Posterior segment injuries included commotio retinae (13.1%) and Berlin's edema (7.4%). Surgical treatment was required in 15 eyes; 107 (88%) were managed conservatively. At study completion, of the 99 eyes evaluated, 21 had reduced visual acuity (<6/6) including 7 with monocular blindness. Factors associated with poor vision were open-globe injury (P < 0.001) and poor initial visual acuity (P = 0.05).Conclusions:Open-globe injury and poor visual acuity at presentation predict the final visual outcome. Monocular blindness following firecracker injury is common.

Surgical Management of Parotid Duct Injury Using a Feeding Tube.

The parotid duct (Stenson's duct) can be damaged during traumatic injuries and surgical interventions. Early diagnosis and treatment of a duct injury is of great importance because complications such as sialocele and salivary gland fistula may develop if the duct is not surgically repaired. We think that the feeding tube is an ideal material in the parotid duct repair because of its technical characteristics, availability, and low cost. In this article, we described the use of a feeding tube for the treatment of a parotid duct rupture in a facial stab wound laceration, as it is a low-cost and easy-to-access material readily available in every operating room.

A Case Report of a Buried Needle in an Oculofacial Trauma

We report a case of a 40-year-old East Asian male who presented with multiple facial lacerations and was referred to oculoplastics for periorbital assessment and wound repair. On wound closure, the needle of a 6-0 vicryl suture accidentally detached, and a mobile image intensifier was used which did not detect a foreign body. Surgical closure was done, but upon computed tomography scan of the face, an embedded foreign material was seen. Difficult secondary wound exploration was performed but with the aid of an intraoperative magnetic probe, the 11-mm needle was identified in entirety.

An audit evaluating Paediatric Laceration CEPOD Waiting Times and Patient Satisfaction; are we meeting expectations?

Introduction/Aims Management of paediatric patients requiring facial laceration repair under general anaesthesia (GA) presents several challenges. This includes availability of resources and time delays due to limited CEPOD capacity which often results in patient dissatisfaction. The aim of this audit is to establish whether paediatric facial lacerations requiring repair under GA are being carried out in a timely manner and whether this is meeting patient expectations.

Injury from electric scooters in Copenhagen: a retrospective cohort study

ObjectiveTo analyse injuries related to manual and electric scooter use from January 2016 up to and including July 2019.SettingElectric scooter rental services were launched in Denmark in January 2019. The...

What Is Injury in Ice Hockey: An Integrative Literature Review on Injury Rates, Injury Definition, and Athlete Exposure in Men's Elite Ice Hockey.

Injuries in men’s elite ice hockey have been studied over the past 40 years, however, there is a lack of consensus on definitions of both injury and athlete exposure. These inconsistencies compromise the reliability and comparability of the research. While many individual studies report injury rates in ice hockey, we are not aware of any literature reviews that have evaluated the definitions of injury and athlete exposure in men’s elite ice hockey. The purpose of this integrative review was to investigate the literature on hockey musculoskeletal injury to determine injury rates and synthesize information about the definitions of injury and athlete exposure. Injury rates varied from 13.8/1000 game athlete exposures to 121/1000 athlete exposures as measured by player-game hours. The majority of variability between studies is explained by differences in the definitions of both injury and athlete exposure. We were unable to find a consensus injury definition in elite ice hockey. In addition, we were unable to observe a consistent athlete exposure metric. We recommend that a consistent injury definition be adopted to evaluate injury risk in elite ice hockey. We recommend that injuries should be defined by a strict list that includes facial lacerations, dental injuries, and fractures. We also recommend that athlete exposure should be quantified using player-game hours.

Facial Artery Pseudoaneurysm in a Child Diagnosed With Point-of-Care Ultrasound

This case describes a 3-year-old boy who was brought to the pediatric emergency department for evaluation of facial swelling. The patient's history was remarkable for a deep facial laceration 5 days prior that required surgical repair in the operating room. On the day of presentation, he was noted to have mild swelling and tenderness to palpation of the left jaw below the mandible, in the same location as his recent laceration repair. Point-of-care ultrasound (POCUS) revealed a pseudoaneurysm with an arterial feeding vessel. This was confirmed by radiology-performed ultrasound, and the patient underwent a coil embolization procedure. To our knowledge, this is the first reported case of a pseudoaneurysm being diagnosed by POCUS in a pediatric patient. This case demonstrates the utility of POCUS in facilitating the timely recognition of vascular mass lesions and guiding management in the emergency department to avoid complications.

A Jaw Crushing Line Drive in a Baseball Pitcher

TITLE: A Jaw Crushing Line Drive in a Baseball Pitcher AUTHORS: Joshua Wilner, MD, Michael Fong, MD (Sponsor: Aaron Rubin, FACSM) INSTITUTIONS: Kaiser Permanente Los Angeles HISTORY: A 23 year old collegiate baseball pitcher sustained a line drive off the right body of his mandible. The patient had a few seconds in which he reported loss of consciousness. After regaining consciousness, he found the baseball at his feet and threw to first in time for the out. At initial medical evaluation, patient complained of pain and bleeding at the right body of his mandible where the baseball made struck him. However, the site of maximal pain was the left superior mandible, where there was no direct trauma. The patient also had concussion symptoms, including headache, confusion, and photophobia. PHYSICAL EXAMINATION: Examination on the field indicated a superficial laceration over the right body of the mandible. There was tenderness and swelling at the right body and left subcondylar aspect of the mandible. He had trismus, but no dysphagia or malocclusion. Patient had a positive concussion evaluation. There was no dental or oral trauma. There was no airway compromise or cervical spine abnormalities. There were no neurological deficits. The patient was sent to the emergency room for further evaluation and imaging. DIFFERENTIAL DIAGNOSIS: 1. Mandible fracture 2. Mandible contusion 3. Mandible dislocation TEST AND RESULTS: CT Scan Head and Mandible: 1. Non-displaced left subcondylar mandible fracture 2. No fracture of right body of mandible 3. No acute intracranial hemorrhage or pathology FINAL DIAGNOSES: Non-displaced, closed left subcondylar mandible fracture Concussion Facial laceration TREATMENT AND OUTCOMES: 1. Mandible fracture was treated with observation and soft diet for 4 weeks. 2. All concussion symptoms resolved within 4 days, and the patient graduated return to play protocol. 3. The laceration was treated with simple interrupted suture repair for 7 days. There were no wound complications. 4. The patient returned to full baseball activities 4 weeks after date of initial injury.

Successful Anesthetic Management of a Patient with Multiple Trauma and Severe Hypothermia: A Case Report

Severe hypothermia with a temperature under 28°C is rarely compatible with life, and there are only a few cases reported in literature where patients have survived such low temperatures. We present the successful anesthetic management of a 30year old male who was found with a body temperature of 26.6°C, unresponsive, and intoxicated with deep facial and neck lacerations in the field, when the outside temperature was -15.6°C. Through proper body rewarming and anesthetic care, we were able to save our patient’s life.

A randomized trial comparing octyl cyanoacrylate tissue adhesive and sutures in the management of facial lacerations

Facial laceration is one of the most common injuries encountered by plastic surgeons. The right material to be used for epidermal closure is a controversial topic with pros and cons of each. The aim of this study was to compare 2-octyl cyanoacrylate tissue adhesive and monofilament sutures for epidermal closure in facial lacerations considering closure time, wound morbidity, and cosmetic outcome. In this study, 90 patients visiting St. John’s hospital, Bangalore, emergency department for facial lacerations were randomly allocated to 1 of 3 groups for the closure using octyl-2-cyanoacrylate–group 1, monofilament nylon 8/0 interrupted sutures–group 2, or monofilament nylon 5/0 subcuticular sutures–group 3 based on simple randomization by computer-generated sequence. All procedures were carried out in the operation theater under sterile precautions by plastic surgery residents. Post-operative follow-up was done on day 1, day 7, and at 3 months. Statistical analysis was done using the one-way ANOVA test and Student’s t test. Time taken for closure using 2-OCA was 4 times faster than the other 2 groups using monofilament sutures. There was no significant statistical difference among the 3 groups with respect to wound morbidity and cosmetic outcome at the end of 3 months. Epidermal closure with tissue adhesive for facial lacerations was faster compared to monofilament sutures with comparable cosmetic outcome at the end of 3 months.

Complications following chin laceration reparation using tissue adhesive compared to suture in children

BackgroundTissue adhesive is widely used in the emergency department to repair minor lacerations but there exists a debate as to whether it should be used for chin lacerations. The main objective of this study was to evaluate the rate of wound dehiscence of chin lacerations repaired with tissue adhesive in comparison to sutures. MethodsThis was a retrospective chart review including all children requiring a facial laceration reparation in a single tertiary care paediatric hospital. The primary outcome was wound dehiscence in the 30 days following reparation, comparing the use of tissue adhesive and sutures. The independent variable of interest was the use of tissue adhesive vs suture. A random sample of charts was reviewed in duplicate to insure reliability of the chart review. ResultsAmong the 2044 children presenting with a facial laceration requiring an intervention, 1804 (88%) were repaired using tissue adhesive. The laceration was located on the chin in 360 (18%) of patients. The use of tissue adhesive was not statistically associated with a higher risk of dehiscence for all facial lacerations (difference: 0.2; 95%CI: −1.9 to 0.8%), nor for chin lacerations (difference 2.2%; 95%CI: −7.5 to 4.4%). However, the probability of dehiscence was higher for chin laceration in comparison to other localizations (difference of 1.6%; 95%CI: 0.5–3.6%). ConclusionWhile the rate of dehiscence was higher for chin lacerations compared to other facial localizations, the risk of dehiscence was not statistically different for chin laceration repaired with tissue adhesive or sutures.

Motorcycle helmet visor–related facial injury and its potential mechanism of injury: Evidence-based case study

Objectives: We encountered an unusual facial laceration wound in relation to motorcycle helmet visor use during our clinical practice. We aimed to assess the prevalence of this unusual facial injury among motorcyclists who sustained facial injuries in selected hospitals and to determine the possible mechanism involved.Methods: We used our prospective cross-sectional substudy involving injured motorcyclists presenting at major trauma hospitals in Southern Klang Valley, Malaysia, between March 2010 and March 2011. of 391 subjects with facial injuries, 2 male motorcyclists sustained this laceration. The wounds were assessed and we believed that each was associated with the helmet visor. One of the visors was collected and the edge was inspected using scanning electron microscopy (SEM).Results: The prevalence of this unusual injury was 0.51% (95% confidence interval, 0.002–0.012) among motorcyclists who sustained facial injuries. Both cases were involved in a head-on collision with their colliding partners and their helmets were intact throughout the crash. The visor in case 1 was intact, but the visor in case 2 was broken. SEM analysis showed that the visor in case 1 had a potential cutting surface.We postulated that with helmet rotation in the forward and downward position and with some degree of visor bending or with a dislodged visor, the sharp-edged visor could potentially severely lacerate the face.Conclusion: This injury affects facial aesthetics and early referral to the facial surgery team is advocated. Documentation of the mechanism of injury, the patient’s helmet and visor is obligatory, so that this information can be delivered to the regional road safety authority for preventive measures.

Windshield glass fragment mimicking a nasal fracture

A male patient with facial trauma by road traffic accident arrived in the emergency room and he was assisted by the Trauma and Neurosurgery team. After clinical evaluation a frontal sinus anterior wall fracture plus a nasal fracture were diagnosed. On the primary OMS examination was checked multiple facial lacerations and gross nasal dorsum deviation with pain, nasal airway obstruction and crepitus with clinical diagnosis of a nasal fracture. After radiologic exam a piece of windshield glass that was superimposed on the nasal bones simulating a nasal fracture was visualized. This paper presents clinical data and literature review of foreign body mimicking facial fractures.Descriptors: Road Traffic Accident; Facial Fractures; Windshield Glass.ReferênciasMazinis E, Lambrianidis T, Margelos J. Detection of a residual foreign body during root canal treatment. J Endod. 2005;31(9):691-93. Gray ST. Windshield safety glass foreign body masquerading as a root fragment. Dentomaxillofac Radiol. 1994;23(1):49-51.Goldstein E, Gottlieb MA. Foreign bodies in the nasal fossae of children. Oral Surg Oral Med Oral Pathol. 1973;36(3):446-47 .Madhere S, Barba CA, Painter RL, Morgan AS. Aspiration of shattered windshield glass after blind nasotracheal intubation in a motor vehicle crash. J Trauma. 1997;43:353-56.

Profile of Birth Injuries in a Tertiary Hospital in Enugu, Nigeria

Background: Birth injury is defined as structural damage of a newborn secondary to mechanical forces that occur during labor and/or delivery. This study determined the incidence, risk factors and outcome of birth injury. Methodology: This was an observational study of birth injuries in neonates, over a period of one year, carried out at a tertiary hospital in Enugu, south east, Nigeria. Results: Out of the 1,735 births recorded during the period of the study, there were 19 cases of birth injuries. This gave an incidence of 11 per 1000 live births. No neonate had more than one injury. They were thirteen males and six females that sustained birth injury. Cephalohematoma was the most common birth injury. Others are caput succedaneum, clavicular fracture, Erb’s palsy, femoral fracture, humeral fracture, shoulder dislocation and facial laceration. Mode of delivery, neonatal birth weight, gestational age and maternal parity were significant predictive risk factors for birth injury. Conclusion: In the current study, cephalohematoma was the most common birth injury, followed by caput succedaneum. There is need to reduce the morbidity and mortality associated with birth injuries.

Tablet Computer as a Distraction Tool During Facial Laceration Repair: A Randomized Trial.

Child life interventions reduce the anxiety of medical procedures but are not always available in emergency departments. In this study, we determined the effect of parent-directed tablet computer use without child life direction on patient anxiety and on parent and suturing clinician experience during pediatric facial laceration repair. In a children's hospital emergency department, we enrolled children 2 to 12 years of age undergoing unsedated facial laceration repairs and randomized them to parent-directed tablet computer distraction or standard supportive care. We measured anxiety using the Observational Scale of Behavioral Distress-Revised (OSBD-R) for 5 procedure phases from videotaped laceration repairs. We compared OSBD-R scores for 5 phases and weighted averages between the tablet and standard care groups. Parents and suturing clinicians completed surveys about their experiences after the procedures. From April 2014 to July 2015, 77 patients (39 tablet, 38 standard) underwent repairs. Age, use of restraint, procedure duration, and number of sutures were similar between the 2 groups. The groups did not differ in procedure phase or weighted-average OSBD-R scores. Parents in the tablet group reported less personal anxiety compared with parents in the standard group (P = 0.01). In a post hoc subgroup analysis, subjects in the unrestrained tablet group had lower OSBD-R scores during the anesthetic injection phase than did subjects in the unrestrained standard group (P = 0.04). If restrained, subjects in the tablet group had higher OSBD-R scores during the anesthetic injection phase than did subjects in the standard group (P = 0.048). Unrestrained children may benefit from parent-directed tablet computer distraction. Parents who operate the device are less anxious during their children's procedures.

Early Complications Following Facial Laceration Repair Performed by Emergency Physicians After One Year of Wound Closure Training.

Facial lacerations, which are common in the emergency department, have usually been repaired by non-facial trauma specialists, such as emergency physicians. Given the ongoing discussion regarding quality assurance or the optimal training model on facial laceration repair for nonspecialists, we sought to determine the impact of a 1-year wound closure training provided to emergency physicians. We hypothesized a decrease in early complications following facial wound closure after the training. A retrospective observational study was conducted between 2013 and 2015 at an academic center. We included patients with isolated facial lacerations that were repaired by emergency physicians and reviewed by board-certified plastic surgeons during a follow-up visit. Patients whose wounds were not reviewed within 3 days were excluded. The 1-year training curriculum, which consisted of several sessions of lecture, hands-on practice, and case review, had been developed by a multidisciplinary team and provided to emergency physicians. Patient data were divided between nonparticipant and participant groups, and a propensity score was developed to estimate the probability of being assigned to the participant group. The incidence of early complications, defined as the need for additional suturing or resuturing due to wound dehiscence, was compared among the groups after propensity score matching. Although 132 patients satisfied all the inclusion criteria, 11 were excluded due to delayed initial wound review. Among the 70 patients who were eventually included in the participant group, 40 were matched with those in the nonparticipant group. The incidence of early complications was significantly lower in the participant group than in the nonparticipant group (5.0% vs. 20.0%, odds ratio = 0.21, 95% confidence interval = 0.07-0.61, p = 0.04). The 1-year training provided to emergency physicians reduced the incidence of early complications following facial laceration repair. Accordingly, future wound closure training models should consider the 1-year training curriculum presented herein.

Comparison of cosmetic appearances after facial lacerations repaired by junior residents and experts

PurposeThe technical factors which improve cosmetic outcomes and which need to be emphasized in education of junior residents have yet to be described. We compared cases in which suturing was performed by either junior emergency medicine residents or experts, in order to determine the focus of future education and training. MethodsWound registry data was reviewed and retrospectively analyzed from September 2015 to February 2016. Only patients who visited the emergency room with facial lacerations were enrolled, and their wound registry data sheets were reviewed. Practitioners were divided into junior resident and expert groups. We assessed the progress using the Stony Brook Scar Evaluation Scale (SBSES) 5–10 days following suturing. ResultsSixty-six patients were enrolled; 43 (65.2%) were men. The median (interquartile range) cosmetic scores (SBSES scale) for suturing performed by junior residents or experts were 3 (2–4) and 5 (4–5), respectively (p = 0.001). The percentage of maximum scores for each SBSES category was significantly lower in the junior resident group than in the expert group for width (68% vs. 86%), hatch marks (68% vs. 93%), and overall appearance (41% vs. 80%) (all p < 0.001). ConclusionsThere were significant differences in scar widths and hatch marks, which were attributable to the skill level of the practitioner who performed the suturing of facial lacerations. Junior residents should be educated about maintenance of proper tension, atraumatic technique, and performing appropriate trimming or debridement.