Resident Manual of Trauma to the Face, Head and Neck

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

b. Other Landmarks Other landmarks should similarly be reapproximated, including the white roll, the philtral ridges, Cupid’s bow, and the mental crease. G. Cheeks y y Examine cheek wounds for possible intraoral communication. y y Note proximity to the course of the parotid duct and major facial nerve branches. y y If blood is seen at Stenson’s orifice, or the depth and location of the wound place the parotid duct at risk, gently cannulate the duct with a lacrimal probe. Overt duct transection, if identified, should be repaired in the operative setting. y y Duct injury signifies higher likelihood of facial nerve injury, particu- larly in the buccal distribution. y y For lacerations medial to the lateral canthi with facial nerve paralysis, identifying nerve branches for primary anastomosis is highly unlikely. H. Chin y y Examine chin injuries for intraoral communication and for anterior fractures or loose teeth. y y Significant auditory meatal trauma should raise suspicion for possible subcondylar mandible fracture. I. Neck y y Consider all neck wounds as penetrating, until proven otherwise. See Chapter 7 for further information on penetrating neck trauma. y y If wounds are superficial, layered closure with reapproximation of the platysma helps to relieve wound tension and ensure adequate blood supply to the overlying skin. y y Place passive drains for large areas of dead space or grossly contami- nated wounds. Fluid accumulation may not only promote infection and wound breakdown, but can threaten the airway if it continues to propagate (Figure 9.5). VI. Perioperative Care A. Antibiotic Prophylaxis 1. Uncontaminated Wounds <24 Hours Mature y y Clean. y y Do not use antibiotic prophylaxis. 2. Contaminated Wounds or Wounds >24 Hours Mature y y Use first-generation cephalosporins (cephalexin, cefadroxyl) or amoxicillin + clavulanate (Augmentin®).

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