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Chapter 9: Soft Tissue Injuries of the Face, Head, and Neck
E. Nose
1. Nasal Soft Tissue Injuries
Nasal soft tissue injuries require closure in three layers.
y
y
Endonasal mucosa should be reapproximated if at all possible as a
first step.
y
y
Alar cartilage lacerations should be reapproximated with 6-0 perma-
nent, monofilament suture.
y
y
Alar rim and columellar lacerations require eversion of the skin
margins to help prevent retraction and notching during scar
maturation.
2. Extensive Nasal Vestibule Injuries
For extensive vestibular injuries, soft silicone stents with mupirocin
ointment should be placed to help maintain vestibular patency during
the healing process. These are affixed to the caudal septal with a
nonresorbable monofilament stitch (Figure 9.4).
3. Septal Hematomas
Septal hematomas require emergent evacuation. The mucoperichon-
drium is coapted to the septal cartilage using plain gut or Vicryl
Rapide™ quilting mattress sutures.
Figure 9.4
Through-and-through laceration of the right nasal soft tissue. Endonasal mucosa
reapproximated followed by realignment of the alar cartilage using 6-0 Prolene. Skin
closure with 6-0 fast-absorbing gut suture. Septal fracture reduced, vestibular margin at
the soft tissue facet closed, and silicone Doyle splints placed.