Facial Plast Surg 2021; 37(04): 473-479
DOI: 10.1055/s-0041-1726440
Original Article

Soft Tissue Trauma to the Nose: Management and Special Considerations

Krystyne Basa
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts
,
Waleed H. Ezzat
1   Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology—Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts
› Author Affiliations

Abstract

The nose is one of the most common sites of facial injury due to its prominence and anatomical placement. Given its intricate anatomy, function, and high visibility, it also proves to be one of the most complex regions for repair. We provide a review of the management of soft tissue injuries to the nose, including the various reconstructive tools available and adjunctive wound care measures. We also discuss special considerations based on mechanism of injury and treatment of this condition in the pediatric population. The main goals of reconstruction should be to preserve function while achieving optimal cosmetic results in this highly visible region of the face.



Publication History

Article published online:
14 April 2021

© 2021. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Hill JD, Hamilton GS. Facial trauma: soft tissue lacerations and burns. In: Flint PW, Haughey BH, Lund VJ, et al. eds. Cummings Otolaryngology: Head and Neck Surgery. 5th ed.. Philadelphia, PA: Mosby Elsevier; 2010: 302-317
  • 2 Hussain K. Management of soft tissue facial wounds. Br J Oral Maxillofac Surg 1995; 33 (04) 265-266
  • 3 Burget GC, Menick FJ. The subunit principle in nasal reconstruction. Plast Reconstr Surg 1985; 76 (02) 239-247
  • 4 Patel RG. Nasal anatomy and function. Facial Plast Surg 2017; 33 (01) 3-8
  • 5 Häfner HM, Schmid U, Moehrle M, Strölin A, Breuninger H. Changes in acral blood flux under local application of ropivacaine and lidocaine with and without an adrenaline additive: a double-blind, randomized, placebo-controlled study. Clin Hemorheol Microcirc 2008; 38 (04) 279-288
  • 6 Tschopp C, Tramèr MR, Schneider A, Zaarour M, Elia N. Benefit and harm of adding epinephrine to a local anesthetic for neuraxial and locoregional anesthesia: a meta-analysis of randomized controlled trials with trial sequential analyses. Anesth Analg 2018; 127 (01) 228-239
  • 7 Zide BM, Swift R. How to block and tackle the face. Plast Reconstr Surg 1998; 101 (03) 840-851
  • 8 Sepehripour S, Dheansa BS. Wound irrigation and the lack of evidence-based practice. J Plast Reconstr Aesthet Surg 2018; 71 (06) 940-941
  • 9 Vásconez HC, Shockley ME, Luce EA. High-energy gunshot wounds to the face. Ann Plast Surg 1996; 36 (01) 18-25
  • 10 Vasconez HC, Buseman JL, Cunningham LL. Management of facial soft tissue injuries in children. J Craniofac Surg 2011; 22 (04) 1320-1326
  • 11 Ramachandra T, Ries WR. Management of nasal and perinasal soft tissue injuries. Facial Plast Surg 2015; 31 (03) 194-200
  • 12 Birdsell DC, Gavelin GE, Kemsley GM, Hein KS. “Staying power”—absorbable vs. nonabsorbable. Plast Reconstr Surg 1981; 68 (05) 742-745
  • 13 Forsch RT, Little SH, Williams C. Laceration repair: a practical approach. Am Fam Physician 2017; 95 (10) 628-636
  • 14 Morris LM, Kellman RM. Are prophylactic antibiotics useful in the management of facial fractures?. Laryngoscope 2014; 124 (06) 1282-1284
  • 15 Zosa BM, Elliott CW, Kurlander DE, Johnson F, Ho VP, Claridge JA. Facing the facts on prophylactic antibiotics for facial fractures: 1 day or less. J Trauma Acute Care Surg 2018; 85 (03) 444-450
  • 16 Meara DJ, Jones LC. Controversies in maxillofacial trauma. Oral Maxillofac Surg Clin North Am 2017; 29 (04) 391-399
  • 17 Forrester J, Wolff C, Choi J, Colling K, Huston J. Surgical Infection Society Guidelines for antibiotic use in patients with traumatic facial fractures. Surg Infect (Larchmt) 2020; (e-pub ahead of print) DOI: 10.1089/sur.2020.107.
  • 18 Liu KY, Silvestri B, Marquez J, Huston TL. Secondary intention healing after mohs surgical excision as an alternative to surgical repair: evaluation of wound characteristics and esthetic outcomes. Ann Plast Surg 2020; 85 (S1, suppl 1): S28-S32
  • 19 van der Eerden PA, Lohuis PJFM, Hart AAM, Mulder WC, Vuyk H. Secondary intention healing after excision of nonmelanoma skin cancer of the head and neck: statistical evaluation of prognostic values of wound characteristics and final cosmetic results. Plast Reconstr Surg 2008; 122 (06) 1747-1755
  • 20 Farrior EH, Eisler LS. Cosmetic concerns related to the posttraumatic nose without nasal obstruction. Facial Plast Surg 2015; 31 (03) 270-279
  • 21 Ebrahimi A, Kazemi HM, Nejadsarvari N. Experience with esthetic reconstruction of complex facial soft tissue trauma: application of the pulsed dye laser. Trauma Mon 2014; 19 (03) e16220
  • 22 Immerman S, Constantinides M, Pribitkin EA, White WM. Nasal soft tissue trauma and management. Facial Plast Surg 2010; 26 (06) 522-531
  • 23 Lu GN, Kriet JD, Humphrey CD. Local cutaneous flaps in nasal reconstruction. Facial Plast Surg 2017; 33 (01) 27-33
  • 24 Kostopoulos E, Casoli V, Agiannidis C. et al. The keystone perforator island flap in nasal reconstruction: an alternative reconstructive option for soft tissue defects up to 2 cm. J Craniofac Surg 2015; 26 (04) 1374-1377
  • 25 Herford AS. Early repair of avulsive facial wounds secondary to trauma using interpolation flaps. J Oral Maxillofac Surg 2004; 62 (08) 959-965
  • 26 Okland TS, Lee YJ, Sanan A, Most SP. The bilobe flap for nasal reconstruction. Facial Plast Surg 2020; 36 (03) 276-280
  • 27 Senturk E, Dagistanli N, Calim OF, Ozturan O. Nasal reconstruction following a dog bite. J Craniofac Surg 2019; 30 (07) 2233-2235
  • 28 Prakash S, Panda R, Kumar V. et al. Nasolabial perforator flap for one-stage reconstruction of nasal defects. J Cutan Aesthet Surg 2017; 10 (01) 22-27
  • 29 Kim IA, Boahene KDO, Byrne PJ, Desai SC. Microvascular flaps in nasal reconstruction. Facial Plast Surg 2017; 33 (01) 74-81
  • 30 Akita S, Yamaji Y, Yamasaki K. et al. Total nasal reconstruction with a nonlaminated vascularized free temporal fascia as the lining. Plast Reconstr Surg Glob Open 2019; 7 (12) e2583
  • 31 Ezzat WH, Liu SW. Comparative study of functional nasal reconstruction using structural reinforcement. JAMA Facial Plast Surg 2017; 19 (04) 318-322
  • 32 Chu EA, Byrne PJ, Odland RM, Goding Jr GS. Skin flap physiology and wound healing. In: Flint PW, Haughey BH, Lund VJ. eds. Cummings Otolaryngology: Head and Neck Surgery. Maryland Heights, MO: Mosby, Inc; 2010: 1064-1079
  • 33 Wright RJ, Murakami CS, Ambro BT. Pediatric nasal injuries and management. Facial Plast Surg 2011; 27 (05) 483-490
  • 34 Alcalá-Galiano A, Arribas-García IJ, Martín-Pérez MA, Romance A, Montalvo-Moreno JJ, Juncos JMM. Pediatric facial fractures: children are not just small adults. Radiographics 2008; 28 (02) 441-461 , quiz 618
  • 35 Hoffmann JF. An Algorithm for the initial management of nasal trauma. Facial Plast Surg 2015; 31 (03) 183-193
  • 36 Alcaraz N, Lawson W. Trauma of the nose and nasoethmoid complex in children and adolescents. Facial Plast Surg Clin North Am 1999; 7: 175-184
  • 37 Javaid M, Feldberg L, Gipson M. Primary repair of dog bites to the face: 40 cases. J R Soc Med 1998; 91 (08) 414-416
  • 38 Chen E, Hornig S, Shepherd SM, Hollander JE. Primary closure of mammalian bites. Acad Emerg Med 2000; 7 (02) 157-161
  • 39 Bhaumik S, Kirubakaran R, Chaudhuri S. Primary closure versus delayed or no closure for traumatic wounds due to mammalian bite. Cochrane Database Syst Rev 2019; 12 (12) CD011822
  • 40 Bula-Rudas FJ, Olcott JL. Human and animal bites. Pediatr Rev 2018; 39 (10) 490-500