Facial Trauma: Difference between revisions
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Manual techniques to the soft tissues, and when required to the Temporomandibular Joint, are the main physiotherapeutic modalities utilised. | Manual techniques to the soft tissues, and when required to the Temporomandibular Joint, are the main physiotherapeutic modalities utilised. | ||
===== Temporomandibular Joint Rehabilitation ===== | ===== [[TMJ Anatomy|Temporomandibular Joint]] Rehabilitation ===== | ||
Please see the Temporomandibular | |||
===== Rehabilitation for Facial Lacerations ===== | ===== Rehabilitation for Facial Lacerations ===== | ||
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===== Nerve Injury Rehabilitation - Trigeminal Nerve ===== | ===== Nerve Injury Rehabilitation - Trigeminal Nerve ===== | ||
===== Nerve Injury Rehabilitation - Facial Nerve ===== | ===== Nerve Injury Rehabilitation - [[Facial Nerve]] ===== | ||
There are a series of pages on this topic; the main one to consult is the [[Facial Palsy]] page. | There are a series of pages on this topic; the main one to consult is the [[Facial Palsy]] page. | ||
Revision as of 22:42, 11 October 2020
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Introduction[edit | edit source]
Trauma to the face and head can be caused by a number of events: explosions, gunshot, road traffic accidents, falling masonry, flying glass, etc.
There can be bony damage - fractures in any of the bones of the head and face, but particularly common in the mandible and nose - and also soft tissue injury. CT scanning is essential as this shows fractures of facial bones more reliably than plain X-ray, and also shows soft tissue injury[1]. Facial and head trauma can also cause damage to the Facial Nerve or the Trigeminal Nerve.
It is important to be aware that a number of patients who suffer trauma to the upper regions of the face also suffer from brain injury[2], and some have co-existing cervical spine injury[2].
Initial repair following serious facial trauma is performed by surgeons; fractured bones will be plated or wired, skin and soft tissue lacerations will be stitched, large areas of severe soft tissue damage may require grafting[3][3][4].
The physiotherapy rehabilitation of these patients is thus largely post operative rehabilitation.
Initial Stages[edit | edit source]
The face has a very rich blood supply, so healing is usually rapid.
Soft Tissue Injury[edit | edit source]
In areas of thin skin (eg. the eyelids) sutures can normally be removed after just 3-4 days, and elsewhere on the face they are often removed after 6 days[5]. Sutures in cartilage, for example the ear or the nose, are often left in situ for 10-14 days.
Bony Injury[edit | edit source]
Surgical repair is often required for bony injury, which may involve wiring or plating, or more substantial surgical techniques to rebuild the damaged bone, such as bone grafting.[2]
Later Stages[edit | edit source]
Once the surgical repair techniques have been completed, the body continues the healing, producing scar tissue.
The proliferation phase of scar tissue lasts for 2-3 weeks, and it is in this phase that the majority of the scar tissue is laid down.
This is followed by the remodelling phase, when the scar tissue continues to rebuild and remodel.
Please see the Soft Tissue Healing page for more details on scar tissue formation.
Physiotherapy following Facial Trauma[edit | edit source]
Rehabilitation should begin as soon as the surgeons permit it.
The aim of physiotherapy is to restore as much facial range of movement as possible, which will result in restoration of facial function.
Clinical Presentation[edit | edit source]
Any of the following may occur, often several in combination:
- Reduced facial range of movement
- Inability to close the eye
- Inability to move the lips eg. into a smile, pucker
- Inability to bite or chew
- Asymmetry of the facial structures
- Difficulties keeping food in the mouth when eating
- Difficulties forming a lip seal on a vessel when drinking
- Dry eye
- Dry mouth
- Reduction in non-verbal communication through facial expression
Rehabilitation[edit | edit source]
Manual techniques to the soft tissues, and when required to the Temporomandibular Joint, are the main physiotherapeutic modalities utilised.
Temporomandibular Joint Rehabilitation[edit | edit source]
Please see the Temporomandibular
Rehabilitation for Facial Lacerations[edit | edit source]
Nerve Injury Rehabilitation - Trigeminal Nerve[edit | edit source]
Nerve Injury Rehabilitation - Facial Nerve[edit | edit source]
There are a series of pages on this topic; the main one to consult is the Facial Palsy page.
References[edit | edit source]
- ↑ Jordan JR, Calhoun KH (2006). "Management of soft tissue trauma and auricular trauma". In Bailey BJ, Johnson JT, Newlands SD, et al. (eds.). Head & Neck Surgery: Otolaryngology. Hagerstwon, MD: Lippincott Williams & Wilkins. pp. 935–36.
- ↑ 2.0 2.1 2.2 Perry M (March 2008). "Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 1: dilemmas in the management of the multiply injured patient with coexisting facial injuries". International Journal of Oral and Maxillofacial Surgery. 37 (3): 209–14
- ↑ 3.0 3.1 Aveta A, Casati P. Soft tissue injuries of the face: early aesthetic reconstruction in polytrauma patients. Ann Ital Chir. 2008;79:415–417
- ↑ James D. Kretlow, Aisha J. McKnight, Shayan A. Izaddoost. "Facial Soft Tissue Trauma" Semin Plast Surg. 2010 Nov; 24(4): 348–356
- ↑ Ardeshirpour F, Shaye DA, Hilger PA. Improving posttraumatic facial scars. Otolaryngol Clin North Am. 2013 Oct. 46(5):867-8
