Pediatric emergency medicine trisk 3303 3303
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FIGURE 107.6 Deep lacerations to the cheek can injure the facial nerve, parotid gland, or
parotid duct. The facial nerve becomes more superficial as it branches and proceeds distally.
Distal nerve injuries can thus occur with more superficial wounds.
Examination for potential injury to Stensen duct is accomplished by grasping
the commissure between the thumb and index finger and gently everting the
buccal mucosa to identify Stensen duct, which lies on a vertical line along the
maxillary second premolar. With the opposite hand, gentle massage of the parotid
gland is accomplished by pressing in the preauricular region. The appearance of
clear fluid from Stensen duct suggests an uninjured duct. The absence of fluid
after several minutes of inspection, or bloody fluid, suggests injury to the gland or
duct. In this case, inspection of the depth of the wound may reveal salivary fluid
and severed ends of the duct may be identified. A sialogram can be a useful
adjunct in the diagnosis of parotid duct injuries, as well as subspecialty
consultation.
Although most lacerations should be repaired within 8 to 12 hours, clean
lacerations of the face can often be reapproximated up to 24 hours after the injury
was sustained. Later closure may be considered after the risks of infection in
closing such a wound are weighed against the benefits of reducing the facial
scarring that will result if the wound is allowed to heal secondarily. Factors such
as mechanism of injury, immunocompetence, and hygiene must be considered.
