Oto Primary Care FINALhigh

Chapter 13

Primary Care Otolaryngology

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

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

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

Figures 13.2 a, b.

Pre- and post-op dermabrasion of

traumatic forehead scars from a car

accident.