Facial Soft Tissue Trauma

Updated: Jun 29, 2021
  • Author: Daniel D Sutphin, MD, FACS; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Practice Essentials

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, 2]

Workup in facial soft tissue trauma

Although most soft tissue facial trauma consists of contusions, abrasions, lacerations, or a combination of these that require only a careful physical examination, more complex wounds benefit from radiologic studies, such as the following:

  • Head and neck films - Plain films of the face, including Water, Caldwell, and lateral views, have been historically important in evaluating for fractures; computed tomography (CT) scanning, however, has greater sensitivity in defining bony facial trauma
  • Arteriography - In patients in whom extensive hemorrhage occurs with a questionable source, arteriography serves as an excellent study to evaluate and isolate the source of hemorrhage or to exclude major vascular injuries
  • CT scanning - CT scanning is an excellent modality for diagnosing more complex facial traumatic injuries

Management of facial soft tissue trauma

The foremost priority in treating any trauma patient is establishing a definitive airway. The use of antibiotics depends on the mechanism of injury (eg, animal or human bite, assault, or motor vehicle accident [MVA]), the degree of injury (superficial or extensive) and concern for devitalized tissue, and the patient’s immune status.

With regard to surgical treatment, if possible, repair facial injuries within the first 8 hours after the initial insult. All forms of facial injuries (eg, abrasions, lacerations, and avulsions) should be well irrigated with isotonic sodium chloride solution before any tissue is handled.

Facial nerve transection is repaired as soon as possible after the injury, ideally within 72 hours. If repair is delayed, the severed ends of the nerve stump tend to contract, making it technically difficult to reapproximate the nerve ends primarily.



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. (Indeed, a retrospective Korean study by Kim et al indicated that in relation to MVAs, wearing a seat belt reduces the likelihood of sustaining a severe soft tissue injury to the face. [3] )

 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. [4, 5, 6, 7, 8]

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. [9] 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.

Using the National Electronic Injury Surveillance System, a study by Bobian et al determined that among 109,795 nursing home residents aged 60 years or older who, between January 1, 2011, and December 31, 2015, suffered facial trauma requiring emergency department care, lacerations (48,679 persons, or 44.3%) and other soft tissue trauma (45,911 persons, or 41.8%) were most common. [10]

A national study from Korea, by Mo et al, indicated that facial lacerations most often occur (40%) in a T-shaped area that includes the forehead, nose, lips, and perioral region. The male-to-female ratio for facial lacerations was 2.16:1, with approximately one third of injuries found in children under age 10 years. [11]



The prognosis for most facial soft tissue injuries is good. Due to the robust vascularity of the facial region, such injuries usually heal rapidly, allowing the patient to return to usual activities, including sports. Knowing the expectations of the patient and his or her family is important in ensuring an optimal treatment result. Likewise, proper management of those expectations, depending on the nature and extent of the injury (eg, clean laceration as opposed to high-velocity avulsion injury with extensive soft tissue loss) is equally imperative. 

Facial soft tissue injury complications include, but are not limited to, infection, hematoma, flap or wound-edge necrosis, nasal septum necrosis, parotid duct laceration with associated siaolocele and/or fistula formation, retained foreign body, poor cosmesis and permanent deformity (eg, cauliflower ear), and loss of function related to facial motor nerve injury, mimetic muscle loss, or scarring. Periocular injuries with associated ectropion can lead to exposure keratitis and prove particularly devastating.


Patient Education

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.