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Resident Manual of Trauma to the Face, Head, and Neck
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Chapter 9: Soft Tissue Injuries of the Face,
Head, and Neck
Matthew Scott Stevens, MD
Christian L. Stallworth, MD
Soft tissue wounding arises from myriad etiologies, from knife or
gunshot wounds to animal injuries, and from assaults to motor vehicle
accidents. As in all trauma cases, airway security, maintenance of
breathing, and circulation are of primary concern. Thereafter, attention
may be turned toward repair of facial trauma. A complete head and
neck exam can often be accomplished in the emergency room or
outpatient surgery facility under local anesthesia with or without
anesthesia monitoring. For difficult or complicated cases, operative
intervention under general anesthesia, particularly in young children or
in those patients with polytrauma or life-threatening injuries, may be
considered. Surgical goals include functional and cosmetic restoration,
while preserving tissue and preventing infection.
The information in this chapter is not meant to describe comprehensive,
long-term care of all traumatic soft tissue injuries. Rather, it serves as a
point of reference for the acute management of most all head and neck
soft tissue trauma.
I. Physical Examination
y
y
Assess airway, breathing, and circulation according to standard
cardiopulmonary life support protocol.
y
y
In the event of central nervous system injury, expanding hematoma in
the lateral pharyngeal space, damage to the tongue, palate, or floor of
the mouth, or disruption of maxillomandibular stability, an endotra-
cheal tube or tracheotomy may be needed for a secure airway.
y
y
Hemostasis is needed for active bleeding. Wound compression will
often suffice. Overt arterial bleeds require vessel ligation or cautery.
Large vessel injury is best addressed in the operative setting.
y
y
Cervical spine injury must be considered present with all significant
facial traumas until ruled out by radiographic studies. A cervical collar
is mandatory in these instances.
y
y
Underlying facial fractures should also be considered irrespective of
the degree of soft tissue injury.