Pediatric emergency medicine trisk 3306 3306
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Lacerations that require subspecialty consultation include those with
injury to deep structures such as nerves or ducts, are associated with
tissue loss, or that involve the cartilage of the ear or nose.
Clinical Considerations
Most facial lacerations can be repaired by the pediatric emergency medicine
physician. Injuries that require subspecialist consultation include (i) lacerations
with evidence of injury to deep structures (a major motor nerve or a glandular
duct), (ii) cases in which a substantial amount of devitalized tissue exists or actual
tissue loss has occurred, (iii) wounds in which the amount of bleeding cannot be
easily controlled, (iv) full-thickness defects of the ear and nose that involve
cartilage, and (v) cases in which it is unclear exactly which tissue to approximate
to restore preinjury anatomy and aesthetics (e.g., lips, eyelids, nostrils, ears).
Suggested Readings and Key References
Goals of Emergency Therapy
Druelinger L, Guenther M, Marchand EG, et al. Radiographic evaluation of the
facial complex. Emerg Med Clin North Am 2000;18:393–410.
Eggensperger Wymann NM, Holzle A, Zachariou Z, et al. Pediatric craniofacial
trauma. J Oral Maxillofac Surg 2008;66:58–64.
Imahara SD, Hopper RA, Wang J, et al. Patterns and outcomes of pediatric facial
fractures in the United States: a survey of the National Trauma Data Bank. J
Am Coll Surg 2008;207:710–716.
Ryan ML, Thorson CM, Otero CA, et al. Pediatric facial trauma: a review of
guidelines for assessment, evaluation, and management in the emergency
department. J Craniofac Surg 2011;22:1183–1189.
Vyas RM, Dickinson BP, Wasson KL, et al. Pediatric facial fractures: current
national incidence, distribution, and health care resource use. J Craniofac Surg
2008;19:339–349.
Facial Fractures
Dogan S, Kalafat UM, Yüksel B, et al. Use of radiography and ultrasonography
for nasal fracture identification in children under 18 years of age presenting to
the ED. Am J Emerg Med 2017;35:465–468.
Foulds JS, Laverick S, MacEwen CJ. “White-eyed” blowout fracture: a case
series of five children. Arch Dis Child 2013;98:445–446.
