The appropriate management of facial soft tissue injuries involves a host of issues and technical considerations. An understanding of the mechanisms involved with wound healing is of greatest importance. Tetanus prophylaxis, wound care of clean and contaminated wounds, proper use and indications for antibiotics, as well as the risks and complications associated with these injuries are all important concerns when dealing with soft tissue injuries. 

Laryngeal trauma is rare, but can be life threatening and life altering. An astute physician will suspect a laryngeal injury whenever there is a change in the voice after a traumatic event or when there are signs of injury to the anterior neck. Careful management of the airway, correct classification of the injury, and thoughtful reconstruction techniques will enable the patient to return to normal function.

Initial treatment of burns to the face is similar to management of burns of the rest of the body. After initial patient stabilization, the next step is operative debridement back to healthy tissue. With burns to the face there is an increased risk of inhalational injury, which compromises the patient’s airway. Due to the complex anatomy of the face, attention during reconstruction must be paid to the facial subunits. If any section of a subunit is damaged, then the entire subunit will be excised and reconstructed en bloc.

As with any trauma, the fundamentals of good trauma care must be followed. The airway must be secure and breathing and circulation must be confirmed. Possible cervical spine (C-spine) injury needs to be ruled out. With mandible fractures, earlier reduction is associated with better outcomes. Although, if other injuries dictate, repair may be delayed 5-7 days, surgical correction is recommended as soon as possible. Current concepts include early intervention with wide surgical exposure to allow for precise alignment and rigid fixation.

Patients with frontal sinus injuries may have significant, life-threatening injuries as the mechanism of injury typically involves significant high-energy blunt force to the anterior skull. Appropriate evaluation, imaging, decision making, and treatment are critical to a successful outcomes and patient management. Concomitant injuries such as: other facial fractures, skull and skull base fractures, dural injuries, CSF leaks, cervical spine fracture, and traumatic brain injury are common.

The surgical treatment goal in repairing midface fractures is to restore masticatory function and orbital function and to restore facial form. Restoration of facial buttresses and dental occlusion restores function and facial width and projection. Restoration of orbital volume and release of incarcerated orbital tissues restores orbital form and function. Midface fractures require a comprehensive timing and treatment plan for each fracture. Lateral canthotomy with inferior cantholysis is a quick way to decompress an orbit involved in midface trauma.

Orbital Fractures are the third most common facial fracture with numerous pre, intra and post-operative complications associated with them. Early recognition and treatment of orbital compartment syndrome is paramount to saving eyesight via canthotomy and cantholysis intervention in close consultation with ophthalmology when possible. Diplopia and enophthalmos are the two most common indications for repair and are ideally treated within 14 days of injury, but can be treated successfully even years later.

Nasal injuries can create a functional as well as cosmetic deficit. The patient with nasal injuries may present a diagnostic and therapeutic dilemma. Often, the associated edema and ecchymosis can mask the extent of the underlying deformity. Careful followup examinations may be necessary in order to make appropriate treatment decisions. The necessity and timing of closed manipulation of nasal fractures must be weighed against open reduction and delayed surgical management, such as a septorhinoplasty procedure.

Temporal bone trauma is a common ENT consult. The complex neurovascular anatomy of the temporal bone directly correlates to significant clinical findings. It is essential to obtain a thorough history and physical especially when determining onset of facial nerve weakness. Recognition of when and which electrodiagnostic tests to order will help guide medical or surgical treatments for facial nerve paralysis. Establishing hearing status also is important to determine nature of hearing loss for purposes of rehabilitation.

Penetrating and blunt neck injuries remain a significant cause of ER presentations and currently make up 1 - 5% of all traumatic injuries, frequently presenting with other concurrent injuries. Mortality for neck trauma patients is quoted between 3% and 6%, a significant improvement over the last century. A clear understanding of the anatomy of the neck and the vital structures found within its three zones is crucial during the initial evaluation and subsequent treatment of these patients.