Case Challenge: A Power Saw Cuts Into a Man's Face

Ronald N. Bogdasarian, MD; Mark S. Granick, MD

Disclosures

January 09, 2017

Case Presentation

A 50-year-old male construction worker was using a circular saw at work when the blade bounced back into his face. Power saws can cause devastating injuries. At the very least, the affected tissues are irregular and heavily damaged. The patient complained of pain and lost teeth but denied loss of consciousness, facial numbness, and changes in vision or bite. The patient had no other significant past medical history and was a nonsmoker. CT of the head and neck demonstrated no fractures. Chest radiograph demonstrated no aspirated or swallowed teeth.

Facial soft tissue trauma is common, occurring in an estimated 15%-25% of all traumas. Mechanisms include assault, motor vehicle collisions, falls, recreation, human and animal bites, industrial accidents, burns, and gunshot wounds.[1,2] Soft tissue injuries to the face present diverse challenges, but the management is simplified by a consistent approach.[3]

The reconstructive plan should begin with stabilization of the patient, including advanced trauma life support for severe cases.[4] A history and thorough physical exam is next. Severely injured or unstable patients should have the wounds cleaned and packed or loosely closed until a definitive reconstruction can be performed. Patients require tetanus prophylaxis when indicated, and antibiotics should be reserved for contaminated wounds and human or animal bites.[5] In this article, we will discuss only patients who have soft tissue injuries that can be repaired in an emergency department setting.

Question 1.

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