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Chapter 9: Soft Tissue Injuries of the Face, Head, and Neck
b. Other Landmarks
Other landmarks should similarly be reapproximated, including the
white roll, the philtral ridges, Cupid’s bow, and the mental crease.
G. Cheeks
y
y
Examine cheek wounds for possible intraoral communication.
y
y
Note proximity to the course of the parotid duct and major facial
nerve branches.
y
y
If blood is seen at Stenson’s orifice, or the depth and location of the
wound place the parotid duct at risk, gently cannulate the duct with a
lacrimal probe. Overt duct transection, if identified, should be
repaired in the operative setting.
y
y
Duct injury signifies higher likelihood of facial nerve injury, particu-
larly in the buccal distribution.
y
y
For lacerations medial to the lateral canthi with facial nerve paralysis,
identifying nerve branches for primary anastomosis is highly unlikely.
H. Chin
y
y
Examine chin injuries for intraoral communication and for anterior
fractures or loose teeth.
y
y
Significant auditory meatal trauma should raise suspicion for possible
subcondylar mandible fracture.
I. Neck
y
y
Consider all neck wounds as penetrating, until proven otherwise. See
Chapter 7 for further information on penetrating neck trauma.
y
y
If wounds are superficial, layered closure with reapproximation of the
platysma helps to relieve wound tension and ensure adequate blood
supply to the overlying skin.
y
y
Place passive drains for large areas of dead space or grossly contami-
nated wounds. Fluid accumulation may not only promote infection
and wound breakdown, but can threaten the airway if it continues to
propagate (Figure 9.5).
VI. Perioperative Care
A. Antibiotic Prophylaxis
1. Uncontaminated Wounds <24 Hours Mature
y
y
Clean.
y
y
Do not use antibiotic prophylaxis.
2. Contaminated Wounds or Wounds >24 Hours Mature
y
y
Use first-generation cephalosporins (cephalexin, cefadroxyl) or
amoxicillin + clavulanate (Augmentin®).