Facial Soft Tissue Trauma 

This article focuses on facial soft tissue trauma. No other part of the body is as conspicuous, unique, or aesthetically significant as the face. Because an individual’s self-image and self-esteem are often derived from his or her own facial appearance, any injury affecting these features requires particular attention.

Patients with traumatic facial injuries often present with extremely disfigured appearances. Such injuries may distract receiving physicians from other potentially life-threatening injuries such as closed head trauma or cervical spine injuries that can be associated with severe facial trauma. Each patient who presents with significant traumatic facial injuries should be treated in accordance with American Trauma Life Support (ATLS) protocols.

Once immediately life-threatening issues such as airway compromise and uncontrolled bleeding have been addressed, other multisystem trauma is excluded. Attention can then be turned to defining and definitively treating the patient’s facial injuries.

Historically, severe facial trauma often resulted in cosmetic and functional defects; however, advances in the science of reconstructive surgery and in the management of trauma patients have significantly improved the morbidity associated with facial traumatic injuries. In the most extreme cases, facial transplantation has even been accomplished at a number of centers throughout the world.^[1]

In the United States, motor vehicle accidents (MVAs) were the most frequent cause of facial injuries before 1970. Since then, with the institution of state seat belt laws, the number of deaths from MVAs has declined, and so has the incidence of facial injuries. However, the prevalence of facial trauma has remained fairly constant. This steady prevalence is attributable to the growing population and to other human factors, such as on-the-job accidents, sports-related injuries, domestic interpersonal violence, self-inflicted wounds, and animal bites.^{[2, 3, 4, 5]}

The mechanism of injury for facial trauma varies widely from one locality to the next, depending significantly on the degree of urbanization, the socioeconomic status of the population, and the cultural background of each region. In rural areas, MVAs continue to be a primary contributor to significant facial injuries. In inner metropolitan areas, however, domestic violence is the leading cause of facial trauma despite a denser population, a difference that may be due to stricter enforcement of traffic laws.

In the United States, approximately 3 million people present to emergency departments (EDs) for treatment of traumatic facial injuries each year. Most of these injuries are relatively minor soft tissue injuries that simply require first-aid care or primary closures.

The exact frequency of facial soft tissue injuries related to sports participation is unknown. This is, in part, due to the minor nature of many injuries, which can lead to underreporting; it may also be due to the wide variation that is seen between demographic groups and between specific sports.

Previous reports estimate sports participation to account for 3-29% of all facial injuries.^[6] In terms of overall sports-related injury, facial trauma accounts for 11-40% of injuries attended to by medical professionals. Most injuries are reported in males, particularly those aged 10-29 years. Sports that mandate the use of helmets and face masks tend to be associated with fewer soft tissue injuries than sports that do not mandate the use of such equipment.

The prognosis for most facial soft tissue injuries is good; the injuries usually heal rapidly, allowing the patient to return to usual activities, including sports. Knowing the expectations of the patient and the patient’s family is important to ensure that the treatment result is optimal.

Facial soft-tissue injury complications include, but are not limited to, infection, hematoma, flap or wound-edge necrosis, nasal septum necrosis, parotid duct laceration, retained foreign body, poor cosmesis and permanent deformity (eg, cauliflower ear), and loss of function related to nerve injury or scarring.

Proper home wound care should be clearly explained to the patient and his or her family.

For patient education resources, see the Eye and Vision Center, as well as Black Eye and Eye Injuries.