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About Face

Chapter Five Accidents Emergency Care Minimizing Scarring Scar Repair Excision Scar Transformation Dermabrasion

Emergency Care

When an accident victim with facial wounding arrives through the emergency door at a hospital, emergency officers do the ABCs of assessing and stabilizing the victim’s injuries before a facial cosmetic surgeon is called to the scene. (The ABCs of trauma are: airway, breathing and circulation.) These doctors have to make sure the patient has a clear airway to the lungs, that he is breathing properly and that his blood pressure is maintaining circulation. Checking for nerve damage is the next step. Where facial nerves are concerned, an otolaryngologist - a head and neck surgeon like myself - is called in.

Different nerves control sensory and motor functions of the face. Sensory functions, like the ability to feel cold, heat or pain, are controlled by branches of the trigeminal nerve. (Part of this nerve also animates the muscles used for chewing.) Motor functions, such as lifting eyebrows or smiling, are controlled by the facial nerve.

The trigeminal and facial nerves are two of the twelve cranial nerves, nerves that grow from the brain stem to the peripheral areas of the head. There are several tests that reveal if these nerves have been damaged, including a simple visual inspection. If wounding is deep in the cheek area or in the glandular area near the base of each ear, it is possible that the facial nerve has been damaged. Or, if the patient shows areas of “hypoesthesia” in the cheeks - insensitivity to pain - a branch of the trigeminal nerve might be ruptured due to a fracture in the eye socket.

Emergency doctors check, too, for any indication of facial paralysis, which would indicate nerve damage. Similarly, if there are broken bones, or other kinds of related injuries, these must be addressed by specialists before any work can begin on repair of the soft tissues of the face.

If a wound is contaminated with foreign objects like dirt or glass, it has to be cleaned out, irrigated. Three-percent hydrogen peroxide, straight from the bottle, is an ideal wound irrigator as it tends to foam away any debris and remove blood staining at the same time. This makes it easier to see more clearly into the wound. Depending on how the wound was caused, doctors might have to administer antibiotics at this stage; dog bites and human bites, for example, almost always justify the use of antibiotics to be on the safe side against possible infection.

After the patient has been stabilized with cleansing and anesthesia, the next task is to preserve all living tissue in the wounded areas and to surgically remove all dead tissue. Of course, because of the copious amount of bleeding in facial wounds, the wounds may have to be cauterized as the doctors proceed. The process of cauterization involves singeing the open ends of blood vessels, one at a time, with an electric current, so that they stop bleeding. Once all the wounds and injuries are assessed, a treatment plan can be started. The emergency doctor might refer the more complex facial injuries to appropriate specialists - like, among others, a facial cosmetic surgeon.

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