Resident Manual of Trauma to the Face, Head and Neck

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

E. Nose 1. Nasal Soft Tissue Injuries Nasal soft tissue injuries require closure in three layers. y y Endonasal mucosa should be reapproximated if at all possible as a first step. y y Alar cartilage lacerations should be reapproximated with 6-0 perma- nent, monofilament suture. y y Alar rim and columellar lacerations require eversion of the skin margins to help prevent retraction and notching during scar maturation. 2. Extensive Nasal Vestibule Injuries For extensive vestibular injuries, soft silicone stents with mupirocin ointment should be placed to help maintain vestibular patency during the healing process. These are affixed to the caudal septal with a nonresorbable monofilament stitch (Figure 9.4). 3. Septal Hematomas Septal hematomas require emergent evacuation. The mucoperichon- drium is coapted to the septal cartilage using plain gut or Vicryl Rapide™ quilting mattress sutures.

Figure 9.4 Through-and-through laceration of the right nasal soft tissue. Endonasal mucosa reapproximated followed by realignment of the alar cartilage using 6-0 Prolene. Skin closure with 6-0 fast-absorbing gut suture. Septal fracture reduced, vestibular margin at the soft tissue facet closed, and silicone Doyle splints placed.

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