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

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

Disclosures

January 09, 2017

The parotid duct is nearby but not in the specific area of the injury. If there is a question about the duct, it can be cannulated and injected with a contrast agent. The facial nerve is critical for facial function and, fortunately, was not significantly injured in this case. Some very distal branches were undoubtedly lacerated, but the need for repair involves larger nerve trunks. The facial artery may well have been severed, but the blood supply in the face is quite redundant and it needs to be ligated, not repaired. The zygomaticus muscle was probably injured, but closure of the muscle layer will account for it because all of the muscles are enveloped in the fascial planes of the face. Distal branches of the infraorbital nerve were probably injured, but these are sensory and not critical to facial function. It is a difficult nerve to repair, even in the proximal areas. Sensation generally recovers to some extent.

Physical Examination

In order to systematically evaluate and document injuries to the soft tissues of the face, various areas can be thought of as facial subunits. These include the scalp/forehead, eyebrows, eyelids, cheeks, ears, nose, lips, tongue, and chin. Each subunit is responsible for key functions, which should be examined thoroughly.[6,7,8,9,10] Each cranial nerve is tested. Anesthetic solution should not be injected until the function of all proximate nerves is assessed.

After a thorough inspection of the wound and normal cranial nerve exam, the patient was anesthetized with bilateral mental and left infraorbital nerve blocks. A 15-cm laceration passed full thickness through the upper left lip down to the gingivobuccal sulcus. Several teeth were injured. The laceration continued through the lower lip adjacent to the oral commissure, then through the mentalis muscle and superficially down the anterior neck to the level of the cricoid cartilage (Figure 1).

Figure 1. Complex, full-thickness laceration through the upper and lower lips. Smile demonstrating intact facial nerve but discontinuity of muscle.

Diagnosis

Complicated facial and neck wounds with associated full-thickness upper- and lower-lip lacerations. Dental injuries.

Wound Management

Question 2.

Comments

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