Soft tissue trauma.

Prior to surgical repair of maxillofacial injuries, a surgeon should formulate an operative plan based upon a careful and complete pre-operative analysis. Obviously this may effect the timing of repair. However, it is more efficacious to delay surgery for up to 24 hours than to close lacerations over a lacerated facial nerve, a severed parotid duct, or other undiagnosed lesions. Repair should include meticulous cleansing and removal of all embedded foreign material if hypertrophy, scars, or tattooing is to be avoided; repair of underlying soft tissue damage, including mucosa, muscle, nerve, cartilage, and subcutaneous tissue; and meticulous closure of the lacerations in accordance with their anatomical location. In wounds involving tissue loss the judicious application of skin grafts, as well as local or regional flaps, is of infinite value. With the careful adherence to the basic principles of plastic reconstructive surgery, the majority of patients with maxillofacial injuries should obtain a good functional and esthetic restoration. In patients in whom this cannot be accomplished because of extensive tissue damage, the primary repair should enhance the feasibility and results of secondary reconstruction.