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Primary Care Otolaryngology
Chapter 13
Facial Plastic Surgery
Facial plastic surgery constitutes a significant part of the practice of otolar-
yngology. Otolaryngologists in both Great Britain and the United States
were founding fathers of plastic surgery as a medical specialty. While extra
training through a fellowship in facial plastic surgery is available for oto-
laryngologists who wish to specialize in this area, all otolaryngologists are
trained in these techniques as a part of their residency. Common proce-
dures vary from the functional—
the repair of traumatic facial
lacera-
tions and fractures
or
reconstruction
after skin cancer and head and
neck cancer—to purely
cosmetic
procedures, such as a facelift
(rhytidec-
tomy)
and injection of soft-tissue fillers or neurotoxins in the office. Some
procedures, such as
rhinoplasty
(corrective nasal surgery), may be both
cosmetic and functional (to improve breathing). Here are some of the
basic principles involved in taking care
of patients with injuries or deformities of
the face.
Facial Trauma
It is often very striking when patients
present after suffering massive facial
trauma. Soft-tissue defects may be pres-
ent, exposing the underlying anatomy.
They may also have some areas of tissue
that are missing. Facial disfigurement
from fractured and displaced facial
bones may be present. Often, there is
blood, mud, or other foreign matter in
the wound.
The workup should begin with the basics of trauma management:
stabili-
zation of the ABCs
,
evaluation of all other associated injuries, and
administration of
antibiotics
and
a tetanus shot
(as indicated). Do not
forget to check to be sure that the
cervical spine
has been cleared.
Figure 13.1.
This patient was an unrestrained passenger
in a motor vehicle accident. He has multiple
facial lacerations, contusions, and fractures.
Remember the ABCs in his management.