Early Treatment of Facial Injuries

Workers, subject to the ordinary risks of everyday life, are potential candidates for trauma to the face.

A significant number of facial injuries result from industrial trauma. No set program can cover the treatment of an injured individual. Emphasis should be placed on the simplest and most direct method which will provide the best outcome and the earliest return to duty.

A prompt and thorough assessment of the injured worker is usually carried out at an emergency room or urgent care center. Since trauma does not respect the boundaries of any specialty, it is the responsibility of the initial triage facility to obtain appropriate consultation whenever necessary. The facility should not be diverted by the most apparent injury or focus therapy slowly within his or her own particular specialty.

Treatment of a facial injury should be guided by the functions of the face and its components.

Physiologically, an airway should be preserved, a solid mobile jaw with functional contiguous soft tissue for normal chewing, talking, and swallowing should be strived for, and functional eyelids for protection of vision should be a goal of any worker who has sustained facial trauma. Too often a facial injury which appears minor to the initial physician ultimately may become serious by developing a tremendous psychological problem for the patient. Therefore, facial trauma must be considered in a slightly different light than similar trauma occurring in most other parts of the body where function is a primary concern and a repair.

In facial injuries, proper measures must be taken for the best possible aesthetic repair. Regardless of the patient's job description, there is a natural human desire to present as normal and as pleasing a facial appearance as possible. The initial repair of a facial injury, if well conceived and properly executed, will often yield a better final result than can be obtained by multiple procedures performed secondarily. Furthermore, additional medical expenses, disability, and time away from work can be avoided.

With proper early care, there would be less tendency toward infection, mal-union of the underlying bones, and other untoward sequelae.

Inadequate primary treatment with superimposition of added trauma may result in deformities which are difficult to correct and certainly prolong morbidity and cost for an injured worker.

In many instances, satisfactory primary repair would be the only correction that is required. Occasionally there may be a need for secondary surgery, however, the best ultimate results can be achieved with few exceptions by an adequate initial restoration of post-traumatic anatomy.

Facial disfigurement and resultant emotional burden on an individual will markedly hinder his social, educational, and economic activities for the remainder of his or her life. Disabling psychological alterations of the facial structures often compound this problem.

These possible sequelae stress the need for applying sound principles of plastic surgery during the early treatment of initial injuries to obtain successful functional and aesthetic results, as well as return to duty at the earliest possible time.

A plastic and reconstructive surgeon will provide insight on the early treatment of facial injuries secondary to industrial trauma.

Issues relevant to Workers Compensation will be addressed, such as when the patient can be expected to return to work and when maximum medical improvement can be expected.

Strategies for successful cost-effective care of facial injuries will be elucidated. The presentation is geared toward non-plastic surgery physicians, nurse-case managers, and adjusters.

Suggestions for employers and risk managers to minimize facial injury claims will be listed.