Avulsion on Woman's Face After a Road Traffic Accident

hermantheshocker · #1 ● 10-03-2021, 12:48 PM

Poona Hospital, Noble Hospital, Pune, India. A 56 years old female presented with a history of a road traffic accident with resultant avulsion of her left side of the face. There was degloving and avulsion of the left hemi-face including the upper lip nose, forehead skin and eyebrow, upper and lower eyelids, and the entire left cheek. The zygomatic bone was also avulsed and displaced laterally. The globe was displaced inferiorly towards the maxillary sinus.

Click image for larger version

Name: 001.jpg
Views: 494
Size: 522.5 KB
ID: 1014297

Fig.1 Preoperative picture showing complete hemifacial and zygomatic avulsion.

Click image for larger version

Name: 002.jpg
Views: 496
Size: 602.5 KB
ID: 1014298

Fig.2 Preoperative picture after debridement and wash.

Click image for larger version

Name: _003.jpg
Views: 495
Size: 626.6 KB
ID: 1014296

Fig.3 Orbit reformed with pieces of zygomatic bone brought into position and fixed with titanium implants.

The patient was immediately resuscitated with airway management, control of bleeding, and maintenance of circulation. Other injuries were quickly ruled out and a CT scan with 3D CT of the face was done. CT scan showed avulsion of the zygoma with a lateral blowout fracture of the orbit. There was no brain injury. The vision was tested for finger counting which was present at 2 to 3 feet. A decision was taken for immediate single-stage reconstruction of the bony as well as soft tissue avulsion.

Click image for larger version

Name: 004.jpg
Views: 501
Size: 574.6 KB
ID: 1014300

Fig.4 Postoperative results.

Click image for larger version

Name: 005.jpg
Views: 498
Size: 327.2 KB
ID: 1014299

Fig.5 Postoperative results after 1 month.

The patient was taken for surgery and under anesthesia, the wound was thoroughly washed with normal saline and diluted betadine solution. All contaminants and foreign bodies were removed. Careful debridement was done and crushed nonviable tissues were excised. The orbital cavity was then reconstructed. The globe was seen to be displaced towards the maxillary sinus. The avulsed zygoma still had soft tissue attachments. There was a piece of lateral orbital rim with the soft tissue flap which was repositioned and the lateral orbital wall was reformed. The fractures were fixed with titanium mini plates. The eyeball was thus repositioned to its original position and the volume of the orbital cavity was restored.

Once the bony fixation was done the soft-tissue reconstruction was started. The degloved flap was repositioned. Tacking sutures were taken to the periosteum wherever possible to keep the flap in place. The upper lip was repaired in layers after marking the anatomical landmarks. The mucosa and muscle were repaired with absorbable sutures and skin with nylon. The nose was reconstructed with repair of the mucosal lining followed by repair of the cartilage framework. The nasal ala was repositioned and the skin was repaired. The eyelids and forehead were repaired in layers. The postoperative course was uneventful. The patient had no problems with visual acuity. The patient was on higher antibiotics for five days and was then discharged. The sutures were removed on the 7th postoperative day. All wounds healed well without any flap necrosis. The patient had normal vision and full facial functions at the six months follow-up.

-

This post is for educational purposes only and is nonprofit. Under Section 107 of the US Copyright Act of 1976; Allowance is made for "Fair Use" for purposes such as criticism, comment, news reporting, teaching, scholarship, and research. OP is not a medical expert. No copyright infringement intended. This post does not encourage or glorify violence/harassment. Images might have been upscaled and enhanced. Text might have been shortened and simplified/reorganized for online view.