National Institute for Health and Care Excellence. Head injury: assessment and early management. Clinical guideline CG176. 2019. www.nice.org.uk/guidance/cg176 (accessed December 2023)
Holmgren E, Schartz D, Ramesh NP Penetrating midface trauma: a case report, review of the literature, and a diagnostic and management protocol. J Oral Maxillofac Surg. 2021; 79:430.e1-430.e12 https://doi.org/10.1016/j.joms.2020.09.031
Phumyoo T, Tansatit T, Rachkeaw N. The soft tissue landmarks to avoid injury to the facial artery during filler and neurotoxin injection at the nasolabial region. J Craniofac Surg. 2014; 25:1885-1889 https://doi.org/10.1097/SCS.0000000000001003
Lee JY, Kim JN, Yoo JY Topographic relationships between the transverse facial artery, branches of the facial nerve, and the parotid duct in the lateral midface in a Korean population. Ann Plast Surg. 2014; 73:321-324 https://doi.org/10.1097/SAP.0b013e31827cd8d9
Bondaz M, Ricard AS, Majoufre-Lefebvre C Facial vein variation: implication for facial transplantation. Plast Reconstr Surg Glob Open. 2014; 2:1-2
Ferreira LM, Minami E, Pereira MD Estudo anatômico do músculo levantador do lábio superior [Anatomical study of the levator labii superioris muscle]. Rev Assoc Med Bras. 1997; 43:185-188
Tomaszewska IM, Zwinczewska H, Gładysz T, Walocha JA. Anatomy and clinical significance of the maxillary nerve: a literature review. Folia Morphol (Warsz). 2015; 74:150-156 https://doi.org/10.5603/FM.2015.0025
Datarkar A, Tayal S. Management of soft tissue injuries in the maxillofacial region. In: Bonanthaya K (eds). Singapore: Springer; 2021
National Institute for Health and Care Excellence. Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use. NICE guideline NG15. 2015. www.nice.org.uk/guidance/ng15 (accessed December 2023)
Prevaldi C, Paolillo C, Locatelli C Management of traumatic wounds in the emergency department: position paper from the Academy of Emergency Medicine and Care (AcEMC) and the World Society of Emergency Surgery (WSES). World J Emerg Surg. 2016; 11
Smith JS. Variations in the aftercare of facial wounds: a survey of maxillofacial clinicians. Br J Oral Maxillofac Surg. 2020; 58:552-555
National Institute for Health and Care Excellence (NICE). Surgical site infection: prevention and treatment. Clinical guideline NG125. 2020. www.nice.org.uk/guidance/ng125 (accessed December 2023)
This case report discusses the management of a patient with severe penetrating wooden branch wounds to the left mid-face following a fall in the garden. Penetrating trauma is classified as an injury that is caused by a foreign object piercing the skin, causing damage to the underlying tissues resulting in an open wound. Penetrating injuries to the head and neck often require attendance to an emergency care unit and subsequent treatment. There are numerous vital structures that can be affected and an understanding of the complex anatomy is vital to the safe management of these patients.
CPD/Clinical Relevance: Treatment of facial trauma demands comprehensive understanding of the vital structures of the head/neck along with efficacious treatment delivery.
Article
An 82-year-old female patient attended A&E after falling into a bush while gardening. She presented with three penetrating branches to the left-hand side of the face (Figure 1). There was no loss of consciousness and the patient remembered the incident entirely.
A medical history was conducted and an urgent CT of the patient's head and face was requested to assess the proximity of the penetrating sticks to vital anatomical structures and to determine the occurrence of intra-cranial injuries (Figure 2). This was in alignment with local health board and NICE guidance given that the patient had a fall and was taking an antiplatelet medication.1 The CT scan would also indicate whether the sticks were of uniform shape or whether they had branches or had splintered such that withdrawal would cause further trauma.
The CT report showed that the largest wooden stick had a diameter of 6 mm and had penetrated the soft tissues of cheek, with a radiographic 33-mm length. The tip of the stick was adjacent to the anterior border of the masseter muscle. There was soft tissue stranding in subcutaneous fat but no evidence of haematoma. The smaller second stick was superior and lateral to the larger stick and had resulted in skin laceration with a penetrating depth of 10 mm. There was no clinical or radiographic evidence of either stick having caused trauma to any vital structures.
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