AAO-HNSF Primary Care Otolaryngology Handbook

CHAPTER 12

Facial Plastic Surgery

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

Facial plastic surgery constitutes a significant part of the practice of otolaryngology. Otolaryngologists in both Great Britain and the United States were founding fathers of plastic surgery as a medical specialty. While extra training through a fellowship in facial plastic surgery is avail- able for otolaryngologists who wish to specialize in this area, all otolar- yngologists are trained in these techniques as a part of their residency. Common procedures vary from the functional— the repair of traumatic facial lacerations and fractures or reconstruction after skin cancer and head and neck cancer—to purely cosmetic procedures, such as a facelift (rhytidectomy) and injection of soft-tissue fillers or neurotoxins in the office. Some procedures, such as rhinoplasty (corrective nasal surgery), may be both cosmetic and functional (to improve breathing). Following are some of the basic principles involved in taking care of patients with injuries or deformities of the face. Facial Trauma

71

It is often very striking when patients present after suffering massive facial trauma (Figure 12.1). Soft-tissue defects may be present, exposing the underlying anatomy. They may also have some areas of tissue that are missing. Facial disfigurement from fractured and displaced facial bones may be present. Often, there is blood, mud, or other foreign matter in the wound. The workup should begin with the basics of trauma management: stabili- zation of the ABCs (Airway, Breathing, Circulation), evaluation of all other

Figure 12.1. This patient was an unrestrained passenger in a motor vehicle accident. He has multiple facial lacerations, contusions, and fractures. Remember the ABCs in his management.

www.entnet.org