Facial Trauma Triage: To Operate or Observe? A Discussion of Commonly-Encountered Scenarios

PROGRAM DESCRIPTION: Management of basic facial trauma falls under the purview of multiple subspecialties within otolaryngology, including facial plastic surgery, head and neck surgery, and comprehensive otolaryngology. These cases are commonly encountered both in the academic setting and in community practice. In fact, the majority of postings for community otolaryngology positions indicate that experience with management of basic facial trauma is preferred. A basic understanding of midface trauma management is therefore an invaluable skill for the otolaryngologist. This panel will discuss midface trauma scenarios commonly encountered by the otolaryngologist, including ZMC facture, zygomatic arch fracture, orbital trauma, and penetrating midface injury. We will discuss what to look for on patient presentation, review relevant CT imaging, and discuss decision making regarding whether and when to operate. We will discuss both fracture management and also other associated soft tissue injuries including management of facial nerve and parotid duct injury. Logistical considerations, including the timing of intervention and when to transfer to a tertiary care center, will be addressed. By reviewing several applicable cases, we hope to provide the audience member with valuable pearls when evaluating and triaging some common midface trauma scenarios.

OUTCOME OBJECTIVE 1: 1. Summarize considerations for the initial evaluation of the midface trauma patient (e.g. physical exam findings, imaging findings)

OUTCOME OBJECTIVE 2: 2. Discuss indications for operative intervention versus observation for some common midface trauma scenarios

OUTCOME OBJECTIVE 3: 3. Discuss logistical considerations for operative intervention (e.g. timing of intervention, when to involve oculoplastics, when to transfer to a tertiary center)

BACKGROUND STATEMENT: As a facial plastic surgeon at a tertiary care center, I take facial trauma call frequently, which involves triaging basic facial trauma transfer requests from the community, many of which stem from a discomfort with basic facial trauma management (an identified 2025 promoted gap).

Comprehensive Otolaryngology Track Statement :