Facial Soft Tissue Injury

The Periodontist is often called on by the Orthodontist for the exposure of an impacted tooth, which is essential for successful orthodontic treatment. The maxillary and mandibular third molars are the most commonly impacted teeth due to their long development time. The maxillary cuspid is the second most frequently impacted tooth. The cuspids are generally one of the last teeth to erupt into the arch and are adversely affected by:

• The loss of space
• Overretained deciduous teeth
• Deflection (facially or palatally) of the lateral incisor

Soft Tissue Injuries can be scars, keloids, contusions, lacerations, puncture wounds, tattoos with debris and avulsive injuries of the skin and soft tissues.

Soft Tissue Injuries may be caused by (chemical, electrical) Burns and Thermal Injuries, Animal or Human Bites (dog bite, snake bite) falls, effects of radiation, motor vehicle accidents, work related, acute and chronic wounds, soft tissue infections resulting in skin defects, violence and physical abuse.

The most common sites for Soft Tissue Injuries are face (eye brows, nose, ears, eyelids, cheeks, lips, chin, jaw), hands, chest, shoulder, knee and upper arms.

Timely and appropriate treatment for Soft Tissue Injuries plays a vital role in determining the extent of disfigurement. Emergency treatment is provided by the primary health care provider, definitive treatment is provided by the plastic surgeon. Soft Tissue Injuries are treated in two phases; immediate treatment of Soft Tissue Injuries (acute phase) and delayed treatment of Soft Tissue Injuries (surgical intervention).

Immediate Treatment of Soft Tissue Injuries.

Immediate Treatment of Soft Tissue Injuries.

• Do not move damaged body part – It may make an injury worse and increase bleeding.
• Ensure patency of Airway – Establishing a patent airway is definitely a priority for the management of Soft Tissue Injuries.
• Visual Examination and Palpation – Examine the face starting from the scalp down to the upper part of neck and side-to-side (from ear-to-ear). Examine for any obvious swellings, depressions, or bruising.
• Stop the Bleeding – Face is a very vascular part of the body therefore, Soft Tissue Injuries have a tendency to bleed profusely. Apply steady pressure for 15 minutes at the site of injury. In case of a nosebleed, apply an ice pack to your nose and cheeks and keep pinching the soft part of your nose for 15 minutes.
• Wound Decontamination and Debridement – This step consists of removing debris, pus, blood, glass or gravel from the wound. This is usually done with cleansing and irrigation with normal saline.
• Wound Assessment – Assess if there is any damage or injury to blood vessels, nerves, tendons, ligaments, joints, bones, or internal organs.
• Medications – Pain medication, antibiotics and a tetanus shot are the first line of treatment.
• Diagnostic Studies – It is important to perform diagnostic tests like x-ray, CT scan, MRI and arteriography to plan appropriate management of complicated Soft Tissue Injuries.
• Wound Exploration – After wound cleansing, using adequate anesthesia to numb the pain and discomfort. Undiscovered foreign bodies, partial tendon lacerations, and joint penetration are more likely to be overlooked if a wound is not adequately explored.
• Wound Closure – Staple closure is not suitable for wounds from Soft Tissue Injuries. Minimal or non-tension sutures significantly impact the esthetic appearance of the wound and play an important role in the mechanism of closure. Observation of the lines of expression is vital to a natural-appearing repair. Wounds on the face may be closed up to 24 hours after injury.
• Repair of Soft Tissue Injuries – Repair of Soft Tissue Injuries within the first 12 – 24 hours is optimum as the tissues are less prone to infection and the healing would be faster.
  Open or Closed Reduction of fracture of the facial bones.

Surgical Intervention for Soft Tissue Injuries.

• Plastic Surgery and Reconstructive Surgery – Consult a Plastic surgeon for complex, cosmetically threatening lacerations or nerve injuries. Plastic surgery procedures like Skin Grafting, Skin Flap Grafting, repair of Facial Injuries, or Mandibular / Maxillary Injuries. Microvascular Surgery is routinely used for reconstruction in the head and neck area. Disfigurement or injury to the nose can be corrected by a Nose Job (Rhinoplasty). Damaged hair on the scalp can be restored by Hair Transplantation technique.