Chen Chen, Mi Jie, Zhou Ling, Li Fei
Department of Burn and Plastic Surgery, Hainan Hospital of Chinese PLA General Hospital, Sanya, China.
Department of Ultrasonography, the first affiliated hospital of the Air Force Medical University, Xi'an, China.
Aesthetic Plast Surg. 2025 Jun;49(11):2915-2924. doi: 10.1007/s00266-025-04664-8. Epub 2025 Jan 14.
Facial trauma repair requires precise reconstruction while preserving aesthetic units. Traditional local anesthesia can distort tissue planes and compromise surgical precision.
This prospective study evaluated landmark-based nerve blocks versus local infiltration for complex facial laceration repair in emergency settings from January 2022 through February 2023. A total of 162 patients were randomized to receive either landmark-based nerve blocks (n = 80) or traditional local anesthesia (n = 82). The nerve block group received targeted injections at anatomical landmarks, while the control group received traditional wound margin infiltration.
The nerve block group demonstrated significantly reduced anesthetic volume (2.03 ± 0.82 mL vs. 4.94 ± 1.71 mL, p < 0.001), lower pain scores (median 2 vs. 5, p < 0.001), and better preservation of facial topography with reduced tissue distortion (0.6 ± 0.5 vs. 1.8 ± 0.7, p<0.001). Superior maintenance of anatomical landmarks (96.3% vs. 88.4%, p = 0.02), aesthetic subunit symmetry (94.8% vs. 87.2%, p = 0.03), and cosmetic junction line alignment (95.5% vs. 86.9%, p = 0.02) was observed in the nerve block group. Three-month POSAS scores showed better outcomes in the nerve block group for both observer and patient assessments (p < 0.01).
While some technical challenges exist with zygomaticofacial and zygomaticotemporal blocks, landmark-based nerve blocks represent an effective approach for complex facial laceration repair, offering improved surgical precision and patient comfort.
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面部创伤修复需要在保留美学单元的同时进行精确重建。传统局部麻醉会使组织平面变形并影响手术精度。
这项前瞻性研究评估了2022年1月至2023年2月在急诊环境中基于体表标志的神经阻滞与局部浸润麻醉用于复杂面部裂伤修复的效果。总共162例患者被随机分为两组，分别接受基于体表标志的神经阻滞（n = 80）或传统局部麻醉（n = 82）。神经阻滞组在解剖标志处进行靶向注射，而对照组接受传统的伤口边缘浸润麻醉。
神经阻滞组的麻醉剂用量显著减少（2.03±0.82 mL对4.94±1.71 mL，p < 0.001），疼痛评分更低（中位数2对5，p < 0.001），并且面部形态保存更好，组织变形减少（0.6±0.5对1.8±0.7，p < 0.001）。神经阻滞组在解剖标志的保留（96.3%对88.4%，p = 0.02）、美学亚单位对称性（94.8%对87.2%，p = 0.03）和美容交界线对齐（95.5%对86.9%，p = 0.02）方面表现更优。三个月后的患者和观察者整体评估量表（POSAS）评分显示，神经阻滞组在两个评估方面均有更好的结果（p < 0.01）。
虽然颧面部和颧颞部阻滞存在一些技术挑战，但基于体表标志的神经阻滞是复杂面部裂伤修复的有效方法，可提高手术精度并提升患者舒适度。
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