Primary Care Otolaryngology

Chapter 13

Facial Plastic Surgery

Facial plastic surgery constitutes a significant part of the practice of otolar- yngology. 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 available for oto- laryngologists who wish to specialize in this area, all otolaryngologists are trained in these techniques as a part of their residency. Common proce- dures vary from the functional— the repair of traumatic facial lacera- tions and fractures or reconstruction after skin cancer and head and neck cancer—to purely cosmetic procedures, such as a facelift (rhytidec- tomy) 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). Here are some of the

86

basic principles involved in taking care of patients with injuries or deformities of the face. Facial Trauma It is often very striking when patients present after suffering massive facial trauma. Soft-tissue defects may be pres- ent, 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.

Figure 13.1. 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.

The workup should begin with the basics of trauma management: stabili- zation of the ABCs , evaluation of all other associated injuries, and administration of antibiotics and a tetanus shot (as indicated). Do not forget to check to be sure that the cervical spine has been cleared.

Primary Care Otolaryngology