Resident Manual of Trauma to the Face, Head and Neck

Chapter 9: Soft Tissue Injuries of the Face, Head, and Neck

Matthew Scott Stevens, MD Christian L. Stallworth, MD

Soft tissue wounding arises from myriad etiologies, from knife or gunshot wounds to animal injuries, and from assaults to motor vehicle accidents. As in all trauma cases, airway security, maintenance of breathing, and circulation are of primary concern. Thereafter, attention may be turned toward repair of facial trauma. A complete head and neck exam can often be accomplished in the emergency room or outpatient surgery facility under local anesthesia with or without anesthesia monitoring. For difficult or complicated cases, operative intervention under general anesthesia, particularly in young children or in those patients with polytrauma or life-threatening injuries, may be considered. Surgical goals include functional and cosmetic restoration, while preserving tissue and preventing infection. The information in this chapter is not meant to describe comprehensive, long-term care of all traumatic soft tissue injuries. Rather, it serves as a point of reference for the acute management of most all head and neck soft tissue trauma. I. Physical Examination y y Assess airway, breathing, and circulation according to standard cardiopulmonary life support protocol. y y In the event of central nervous system injury, expanding hematoma in the lateral pharyngeal space, damage to the tongue, palate, or floor of the mouth, or disruption of maxillomandibular stability, an endotra- cheal tube or tracheotomy may be needed for a secure airway. y y Hemostasis is needed for active bleeding. Wound compression will often suffice. Overt arterial bleeds require vessel ligation or cautery. Large vessel injury is best addressed in the operative setting. y y Cervical spine injury must be considered present with all significant facial traumas until ruled out by radiographic studies. A cervical collar is mandatory in these instances. y y Underlying facial fractures should also be considered irrespective of the degree of soft tissue injury.

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Resident Manual of Trauma to the Face, Head, and Neck