Overview of Oral and Maxillofacial Surgery, Facial Laceration Repair
In the United States, about 2 million people go to the emergency-room every year for face cuts. Because of this, it’s really important for doctors and nurses in primary and emergency care to understand how to manage these injuries. If not handled properly, these cuts can cause lasting damage that can affect a person’s quality of life.
Scars on the face can have negative effects socially and functionally. As a result, treating a face injury quickly and correctly is really important to minimize scarring and increase patient satisfaction. Fixing complex face structures involves keen attention to detail, along with proper care of the wound like cleaning it thoroughly, preventing infection, giving a tetanus shot if necessary, and doing what can be done to prevent scarring.
To give the best care for patients with face cuts, healthcare providers need to understand the different structures of the face and how to handle the common problems associated with repairing face cuts.
Anatomy and Physiology of Oral and Maxillofacial Surgery, Facial Laceration Repair
The face and head consist of 8 separate segments, each with their own special characteristics. Medical professionals need to understand these in order to properly treat any cuts or wounds.
The scalp, for instance, is made of 5 layers. In order from surface to the deepest parts, these are the skin, fat under the skin, a tough layer called the galea aponeurotica, loose tissue, and a layer that is tightly stuck to the skull called periosteum. If you’d like to remember these layers, the acronym SCALP might help. The scalp contains about 100,000 hair follicles and is given blood supply by both the external and internal carotid arteries. Because of this, scalp injuries may bleed a lot, due to little constriction of these blood vessels.
The forehead is the next section, defined as the area from above the eyebrows to the hairline. Like the scalp, the forehead has several layers, and the muscles in this area can cause vertical or horizontal lines to form on the skin, so scars may be placed along these lines to hide them better. The forehead also receives blood supply from both external and internal carotid arteries. The nerves to this area are the supraorbital and supratrochlear nerves, and the facial nerve is responsible for the forehead’s movement.
Moving to the cheek, it extends from below the eye down to the jawline and from the side of the nose over to the in front of the ear. It has layers of skin, subcutaneous tissue (under the skin), and something called the superficial musculoaponeurotic system (SMAS), which helps with facial expression. There’s also loose tissue that allows the face’s muscles to move, and the deep parotidomasseteric fascia (a layer of connective tissue). Blood supply to the cheek comes from the ophthalmic artery, which equally splits and goes to the middle and side of the cheek. Sensitivity in the cheek comes from the trigeminal nerve, and movement comes from the facial nerve.
Any injury to the cheek should also include a check on the facial nerve as well as the parotid gland and duct, which are responsible for creating saliva. The facial nerve splits into top and bottom branches that help make our many facial expressions possible. Given the many elements in this area, any damage could potentially affect multiple areas.
Why do People Need Oral and Maxillofacial Surgery, Facial Laceration Repair
If you get hurt on your head or face, it’s important to have a detailed check-up. Small scratches or injuries that only affect the outermost layer of your skin might be treated with simple care at home, allowing them to heal naturally over time. But even if your wound seems minor, you should always have it thoroughly checked by a medical professional to make sure that no other structures like bones, blood vessels, or nerves have been hurt.
Stitching up the wound can start once all the other face injuries have been taken care of. For wounds that go through multiple layers of tissue, the stitches need to be placed in layers too. This helps to restore the full strength of the skin and to prevent the wound from opening up again or scarring badly.
When a Person Should Avoid Oral and Maxillofacial Surgery, Facial Laceration Repair
Emergency injuries like brain or chest trauma need immediate attention, and hence, are a priority over treating cuts or slashes. Ensuring a patient is able to breathe accurately and keeping their blood circulation stable are the main focus during a trauma case. If a patient is stable, cuts on the face or head should not be treated until other bone or structural facial injuries have been checked and decided if they need surgery or specialized treatment has been determined. In some scenarios, these facial cuts offer the best access to treat the underlying bone injuries.
In occasions where a patient gets injured, say from a car accident, a fall, or a physical fight – facial cuts are common. In such cases, it’s essential always to check and protect the neck as well.
If a wound looks really infected or there’s a lot of dirt or contamination in it, it’s best not to stitch it up as it could lead to a collection of pus. The same worry of infection exists for wounds seen 24 hours post-injury. Cuts that show up more than 24 hours after injury without proper cleaning and treatment carry a higher risk of wound infection, and so should either be treated later or left to heal naturally. If there’s a loss of extensive skin or any need for removal of dead, damaged, or infected tissue, or if the cuts cannot be fixed at the bedside without strain, it may be best to consider a detailed repair in an operating room.
Equipment used for Oral and Maxillofacial Surgery, Facial Laceration Repair
Fixing a cut or tear in the skin, also known as laceration repair, needs specific tools and materials:
• A liter or more of sterilized saltwater (saline) for cleansing the wound
• A large syringe, either with a bulb or a catheter tip, to apply the saline for wound cleaning
• Disinfectants like povidone iodine or chlorhexidine to kill any potential germs
• Local anesthetic for numbing the area and decreases pain during the procedure
• Different sizes of needles (18- and 27-gauge) for administering and applying the anesthetic
• A 10 mL syringe for administering and applying anesthetic
• Sterilized gloves to maintain cleanliness and avoid infection
• Suction to remove any fluids or debris from the wound
• Gauze sponges for wound cleaning and to soak up any blood or fluids
• Special forceps, such as Castroviejo or Adson-Brown forceps, and needle drivers like Castroviejo or Halsey for precise handling of sutures (stitches)
• Suture scissors, like the Mayo or Iris, to correctly size and place the sutures
• Different kinds of sutures or stitches (ranging from 3-0 through 6-0 in size) both absorbable and non-absorbable, monofilament and braided materials. The type selected depends on where the cut is and what body parts are affected.
• Antibiotic ointment or adhesive strip bandage tapes to protect the wound after the procedure.
Who is needed to perform Oral and Maxillofacial Surgery, Facial Laceration Repair?
Doctors who provide emergency care or general health care are generally knowledgeable in basic stitching techniques and how to handle damaged tissue. This means they can fix straightforward facial cuts. However, if the injuries are more complicated and have affected parts like the eyeball, salivary gland duct, facial nerve, tears drainage system, eyelid edge, or if there’s a significant loss of tissue, or if multiple layers of tissue are damaged needing complex restoration, then a specialized surgeon should be called in. They will assess and manage the injury accordingly.
Preparing for Oral and Maxillofacial Surgery, Facial Laceration Repair
Before starting any treatment to stitch up a cut or wound (known as laceration repair), the doctor must explain to the patient everything about the procedure, the recovery process, and the outcomes. This is called getting “informed consent” and is a crucial part of providing care.
The doctor will provide the patient with detailed instructions on how to take care of the wound after the procedure. The patient, or someone accompanying the patient, should understand these instructions both before and after treatment.
The doctor may discuss with the patient about certain factors that can affect how well a wound heals. People with weak immune systems – due to chronic illnesses, poor nutrition, or problems like smoking or uncontrolled diabetes – might have more difficulty healing their wounds. The doctor might suggest ways to improve these issues, for instance, quitting tobacco or managing diabetes better.
The doctor will also examine the patient thoroughly and ask questions about their medical history. This step is important to identify and consider any other potential injuries. The doctor can take photos of the wound before and after the treatment to document the healing process.
Some patients might have a hard time coming back to the doctor’s office for follow-up. In such cases, the doctor will use stitches that dissolve on their own instead of the ones that need to be removed later.
To stitch up a wound properly, the doctor needs appropriate tools and suitable lighting. Depending on how severe the injury is, the treatment might be done right at the doctor’s office with the patient awake, or in an operation room with the patient asleep (under general anesthesia).
Before starting the procedure, the doctor will check the nerves around the wound to record their normal functioning. This information is used to make sure that any changes in nerve functions after the treatment are actually caused by the treatment itself.
Also, the doctor might prescribe medicines to prevent infections from certain types of wounds. For instance, antibiotics and possibly rabies vaccination are recommended if the wound is due to a bite from a dog, cat, or another person. Patients with allergies can be given alternative medicines. They might also need shots to prevent tetanus, a severe bacterial infection.
Before starting, the doctor will clean the wound thoroughly and remove any dirt or other foreign material. If the wound is deeper than it is wide or if more than 24 hours has passed since the wound happened, the doctor might decide not to stitch it up right away or let it heal naturally. They will examine the wound from time to time and make the best decision based on its condition.
How is Oral and Maxillofacial Surgery, Facial Laceration Repair performed
Whenever a wound needs to be treated, one of the first steps is to numb the area using an anesthetic. This helps to decrease any discomfort you might feel during the procedure and allows the healthcare provider to gently clean the wound without causing pain. There are different ways to numb the area. One way is to apply a gel or a solution (like a mix of lidocaine, epinephrine, and tetracaine) directly onto the wound area before giving a local anesthetic injection.
Another option is regional anesthesia, also known as nerve block. This kind of anesthesia numbs a specific area of the face and allows the healthcare provider to treat the wound without causing any discomfort. This is particularly useful in areas where the wound edges need to be carefully aligned for healing, such as the lip.
When nerve block fails or isn’t really needed, local infiltration (injecting an anesthetic directly into the wound area) should provide enough numbing. Using an anesthetic mixture that includes epinephrine can also help to control bleeding.
It’s important to note that the application of anesthetic solutions can temporarily impact motor function. That’s why the healthcare provider needs to evaluate motor and sensory function before injection. If a nerve is damaged and needs to be repaired, the procedure should be performed under general anesthesia.
After making sure that the wound area is adequately numb, the next step is to clean the wound. Remember that cleaning the wound helps to decrease the risk of infection and improves the visibility of tissue layers, making it easier for the healthcare provider to treat the wound. Warm sterile saline irrigation (rinsing the wound with a salt-water solution) is usually enough to clean facial wounds.
Once the wound has been cleaned, the healthcare provider will check the wound for any bleeding. If there is active bleeding, direct pressure or tying off the bleeding vessel may be necessary.
Next, the wound will be evaluated to see if it can be closed without any tension (pulling on the skin). The healthcare provider might need to shave hair around the wound in order to see clearly. The wound should then be repaired in a way that prevents any unnecessary damage to the skin.
The repair method could differ depending on the location of the wound. For example, scalp wounds can bleed a lot and may need a transfusion. Once bleeding is controlled, superficial scalp wounds can be closed with staples or sutures. Deeper wounds might need layered closure with different stitches and sutures. If the wound is on the forehead, it’s necessary to repair the wound following the natural lines on the forehead to help hide the scar.
For wounds on the cheek, it’s essential to check the salivary gland and nerve before starting repair. If nerve damage is found, sutures may be used for repair under a microscope. If there is damage to the salivary gland, further evaluation and repair are needed before repairing the skin laceration.
Possible Complications of Oral and Maxillofacial Surgery, Facial Laceration Repair
After a wound repair, there could be complications such as scarring or the formation of keloids, which are raised scars that grow larger than the original wound. Factors such as too much tension on the stitched area, not bringing the wound edges evenly together, or not lifting the wound edges enough can lead to poorer appearances of the healed wound. Some people are more prone to developing keloids or heavy scarring. If a patient has a history of this happening after previous surgery or injury, doctors should explain that there could be a higher chance of heavy scarring even if the wound is treated and stitched up very well. Luckily, it’s rare for keloids to form on the face itself, though they can often appear on the scalp, back of the neck, and ears in individuals prone to them.
There are several treatment options for improving the appearance of scars, which include injections of corticosteroid into the scar, dermabrasion (a skin smoothing technique), laser treatment, and surgical revisions. The steroid injections can help ease inflammation and make the scars softer or reduce thickened scar tissue by slowing down the activity of cells called fibroblasts. However, these injections also can thin the skin, cause fat loss beneath the skin, and create networks of dilated blood vessels on the skin’s surface called telangiectasias. Dermabrasion involves shaving off the skin’s top layer to promote new skin growth and collagen production, a protein that gives skin its strength and flexibility. Lasers can also be used to smooth out skin by evaporating the water within skin cells. Surgical chopice involves removing the scar and using techniques to enhance the scar’s alignment for a better cosmetic look. These techniques can be used in combination for the best results.
Scarring can sometimes discomfort or cosmetically disturbing over time, but there are more immediate complications to look out for after a wound repair. Hematomas (swelling filled with blood) and infections are common early complications. Being thorough about stopping any bleeding before closing the wound can minimize the risk of a hematoma. The wound should be checked for anything left inside, like dirt or glass, before closure – because drastically increasing the risk of getting a wound infection.
If an infection happens, antibiotics should be given, and the wound should be thoroughly cleaned, possibly needing a minor surgical cleaning if needed. The wound may then need to be loosely closed over a surgical drain to let out fluid build-up, or left open and managed with bandages until the infection is gone. For a hematoma, it might also require reopening the wound, controlling any bleeding, and possibly closing it again over a surgical drain to help fluid escape. Less serious hematomas might just be managed with pressure dressings and warm compresses, and possible needle drainage.
What Else Should I Know About Oral and Maxillofacial Surgery, Facial Laceration Repair?
When fixing a cut on the face, it’s important to know about the part of the body affected and the best ways to manage the skin. If a cut on the face isn’t treated correctly, it can result in a poor look. This might make the person feel bad, anxious, or stressed, and could leave them with scars, changes in the look of their face, or problems with how the face works.
Doctors usually talk to patients about the options for treating the cut and what they might expect after treatment. This helps to create trust between the doctor and patient and makes both of them happier with the result in the long run.
