Current Concepts in the Management of Facial Trauma

The risk of injury to the human psyche is no greater than when one suffers from facial trauma. Restoration of form and function is paramount.

The two great world wars of the last century initiated the greatest advances in facial trauma repair in the history of human existence. Then, the accelerating advances in mechanization and transportation ushered in an era of a high incidence of noncombat facial injuries.

In the 1940s, Dr. William Milton Adams, from Memphis, Tennessee, popularized open reduction and internal wire fixation of facial fractures. This proved to be a significant advance over the use of bandages, splints, head-caps, and complex external devices. Physicians had never before been able to more closely restore facial structure. Wire fixation remained the standard of care until the mid-1980s, when metal fixation plates became widely available. As a result, repair has become even more accurate. Of course, while extremely comminuted fractures and tissue loss remain a challenge, concomitant injuries and overall health continue to confront the restorative surgeon.

In this issue of Facial Plastic Surgery, we not only look at surgical approaches designed to minimize the use of external incisions to repair skeletal injuries but also review the use of miniplate fixation techniques as well as the repair of specific fractures.

Because no facial trauma care center is limited to the treatment of simple bony fractures, we also discuss the management of facial gunshot wounds and associated injuries, such as laryngotracheal separation and skull base fractures.

Facial injuries, especially complex deformities, continue to challenge us. It is my hope that we will all benefit from the information obtained from the experiences that come through the contributors to this issue.

Phillip R. Langsdon, M.D., F.A.C.S.