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Facial Trauma

Patient assessment

By Mike Mikkelsen Lorenzen, MD and Magnus Balslev Avnstorp, MD

A thorough examination must be performed to assess the potential injuries from the relevant trauma. Thus, mechanism of trauma as well as a brief patient history is needed. The initial assessment is important in order to differentiate between major and minor traumas and the subsequent treatment.

Prior to any treatment the following must be assessed:

  • Vascular integrity (distal pulse and capillary response)
  • Function (movement)
  • Nervous integrity (motor as well as sensory)

In head and neck trauma it is important to differentiate between minor traumas including lacerations or major traumas including bone and intracranial lesions. This requires relevant assessment through x-ray or computed tomography and is beyond the scope of this chapter.

In lesions near openings such as the mouth (lips), eyes, nose or ears it is paramount to assess wound depth and the potential affection of deeper structures, as these require suturing prior to skin closure.
In terms of superficial injuries, laceration repair can be assessed and sutured primarily.

Following repair near facial openings dragging of lips, eyelids and nostrils must be avoided.