28: Soft Tissue Injuries

Chapter 28
Soft Tissue Injuries

Soft tissue injuries are one of the most common problems treated in the emergency rooms and the facial region is an esthetically sensitive area with a complex variety of tissues. Around one-third of patients presenting with oral injuries have sustained soft tissue injuries.

Soft tissue in the oral and maxillofacial region absorbs a lot of energy when the region is subjected to impact from trauma. This may result in various injuries such as contusions, abrasions, lacerations and tissue avulsion. Foreign bodies are often found in the tissue. Teeth often penetrate the soft tissue and parts of the teeth may be found as foreign bodies in lacerations. Correct emergency treatment is a prerequisite for uneventful healing and the oral and maxillofacial region is an esthetically sensitive area. Failure to remove foreign bodies may result in permanent tattoos and unesthetic scarring and delayed healing and infection.

Types of Soft Tissue Trauma

Soft tissue injuries can be divided into the following types of injuries:

  • Contusion
  • Abrasion
  • Laceration
  • Tissue avulsion.

Contusion

A contusion is a bruise without a break in the skin or mucosa. Subcutaneous or submucosal hemorrhage in the tissue results in hematoma and swelling of tissue is seen (Figs 28.1, 28.2). A contusion may be isolated to the soft tissue but often indicates a deeper injury, such as an underlying bone fracture.

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Fig. 28.1  Contusion injury with periorbital hematoma. In this patient there was an underlying bone fracture. (From Andersson and Andreasen 2007.)
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Fig. 28.2  Hematoma of soft tissue. Perimandibular hematoma may indicate underlying bone fracture as in this patient. (From Andersson and Andreasen 2007.)

Abrasion

An abrasion is a superficial wound in the skin or mucosa produced by rubbing and scraping of the skin or mucosa leaving a raw, bleeding, and often very painful surface (Fig. 28.3).

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Fig. 28.3  Abrasion of the upper and lower lip. (From Andersson and Andreasen 2007.)

Laceration

Laceration is a wound in the skin or mucosa penetrating into the soft tissue (Fig. 28.4). A laceration may disrupt blood vessels, nerves, muscles, and involve salivary glands. The most frequently occurring lacerations in the maxillofacial region are seen in lips, oral mucosa, and gingiva. More seldom the tongue is involved.

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Fig. 28.4  Laceration of upper lip. (From Andersson and Andreasen 2007.)

Avulsion

Avulsion (loss of tissue) injuries are rare but seen with bite injuries or as a result of a very deep and extended abrasion (Fig. 28.5).

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Fig. 28.5  (a) Avulsion injury of lower lip showing 2 cm wide avulsion injury. (b) Avulsion injury of lower lip showing considerable anterior loss of tissue of the vermillion. Nevertheless this was left for spontaneous healing without flaps or grafts. (c) Final result 1 year after trauma. A normal contour of the lip is seen. (d) Scar tissue is seen centrally in a circular area (9 mm diameter) at the vermillion border. (From Andersson and Andreasen 2007.)

Emergency Management of Soft Tissue Injuries

Besides medical history and history of medications it is important to determine the mechanisms of injury and time of occurrence to provide information of any potential foreign bodies that may affect healing. Moreover, it is important to know the tetanus immunization status of the patient.

Abrasion

Abrasions require thorough lavage and irrigation along with careful inspection and removal of any solid remnants and necrotic epithelium. Remaining irritants may be the source of prolonged inflammation, infection, and discolorat/>

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Jan 12, 2015 | Posted by in Oral and Maxillofacial Surgery | Comments Off on 28: Soft Tissue Injuries
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