AAO-HNSF Primary Care Otolaryngology Handbook

FACIAL PLASTIC SURGERY

usually around seven days. It is important for patients to realize that scars take a minimum of one year to cosmetically mature. The time course usually involves the scar turning red, with the maximum redness occur- ring at approximately six weeks. The scar then tends to fade to purple and brown before eventually turning white. In general, scar revisions are not performed until a scar has fully matured. Sunscreen should be used for at least the first year after the injury, because scars can become hyperpig- mented with exposure to sunlight. If hypertrophic scars form, steroid injections directly into them can help. Early dermabrasion (like sanding a piece of wood), at six to eight weeks, has been used with success in

reducing scarring (Figures 12.2 a, b). Timing of this procedure is critical. Covering the wound with silastic sheeting may also decrease the likelihood of excessive scarring. In addition to soft-tissue injuries, repair of facial skeletal fractures is often necessary. The most common facial fracture is a broken nose . Depending on the degree of this injury, management may be as simple as control of bleeding with ice and nasal spray, or may require surgery. Most significant nasal frac- tures are obvious on physical exam. Radiographs are not particularly helpful for diagnosis, but are commonly taken for docu- mentation purposes. Reduction of displaced fractures can be done in the emergency room if sedation is available, but may require a trip to the operating room. Once the bones are manually moved to their original position, a “splint” or cast is

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Figures 12.2 a, b. Pre- and post-op dermabrasion of traumatic forehead scars from a car accident.

commonly placed both internally and externally to hold the bones in position while they heal. More significant fractures, such as those of the mandible or midfacial skeleton, are typically evaluated by computed tomography scanning. If the bones are displaced, surgery (open reduction and internal fixation) may be needed. Titanium microplates are commonly used to repair facial fractures now. Some maxillomandibular fractures can be managed without surgery (closed), using temporary “braces” (arch bars) or a soft diet. Septorhinoplasty Perhaps the most common form of facial plastic surgery that an otolaryn- gologist performs is septorhinoplasty . In this operation, the deviated

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