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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
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If injury is identified, rule out an underlying cranial fracture.
7. Cranial Nerves
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A thorough cranial nerve exam is mandatory, particularly in cases of
extensive soft tissue trauma. Like all many neurologic evaluations,
though, this is difficult in the obtunded patient.
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Paresthesias are common even in contusions, but may help isolate
underlying fractures in the maxillomandibular skeleton.
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Facial nerve status is of utmost importance as well. In cases of
lacerations and penetrating injuries, nerve sectioning must be ruled
out. Contusions and localized inflammation can lead to neuropraxia,
but this typically presents in a delayed fashion. Documenting facial
function early in the course of treatment can be invaluable for
long-term prognosis—both in soft tissue trauma and in the manage-
ment of temporal bone fractures.
II. Diagnosis, Imaging Studies, and Laboratory
Assessment
A. Diagnosis
Soft tissue injuries are essentially all identified by a thorough history
and physical exam. The extent of injury, though, may be further charac-
terized with the assistance of ancillary studies.
B. Imaging Studies
1. Plain Film Radiographs
Plain film radiographs are primarily useful for evaluating cervical spine
status. Typically initiated by the primary emergency medicine or trauma
service, they have limited value for assessing most craniofacial trau-
matic injuries.
2. Computed Tomography (CT)
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CT imaging of the face
≤
3 millimeters (mm) cuts in both axial and
coronal dimensions is adequate. Cuts of 1 mm or less are optimal, and
provide opportunity for more accurate reconstructed coronal images
of detailed 3-dimensional reconstructions if desired.
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CT provides excellent delineation of bony architecture.
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CT can demonstrate radiopaque foreign bodies that may be embed-
ded in soft tissue.
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CT, in combination with contrast material, can delineate vascular
structures.
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CT angiography is ideal for penetrating neck trauma if this modality is
available.