Primary Care Otolaryngology

Chapter 13

approximately six weeks. The scar then tends to fade to purple and brown before eventually turning white. In general, scar revisions are not per- formed until a scar has fully matured. Sunscreen should be used for at least the first year after the injury, because scars can become hyperpig- mented with exposure to the sun. If hypertrophic scars tend to form, ste- roid injections directly into them can help. Recently, early dermabrasion (like sanding a piece of wood), at six to eight weeks, has been used with success in reducing scarring. Timing of this procedure is critical. Covering the wound with silastic sheeting may also decrease scars. In addition to soft-tissue injuries, repair of facial skeletal fractures is often necessary. The most common facial fracture is a broken nose. Depending

88

on the degree of this injury, management may be as simple as control of bleeding with ice and nasal spray, or may require surgery. Most significant nasal fractures are obvious on physical exam. Radiographs are not particu- larly helpful for diagnosis, but are commonly taken for documentation purposes. Reduction of displaced fractures can be done in the emergency room if sedation is available, but may require a trip to the operating room. Once the bones are manually moved to their original position, a “splint” or cast is com- monly placed both internally and externally to hold the bones in position while they heal. More significant fractures, such as those of the mandible or midfacial skeleton, are typically evaluated by CT scanning. If the bones are displaced, surgery (open reduction and inter- nal fixation) may be needed. Titanium microplates are commonly used to repair

Figures 13.2 a, b. Pre- and post-op dermabrasion of traumatic forehead scars from a car accident.

facial fractures now. Some maxillomandibular fractures can be managed without surgery (closed), using temporary “braces” (arch bars) or a soft diet. Septorhinoplasty Perhaps the most common form of facial plastic surgery that an otolaryn- gologist performs is septorhinoplasty . In this operation, the deviated sep- tum is straightened, and the outside of the nose may also be changed in form through various surgical maneuvers. The most common procedure is straightening the septum (septoplasty) , which is performed through the

Primary Care Otolaryngology