DISCUSSION:
Facial soft tissue injuries are a common occurrence in the pediatric
population. Although rarely life-threatening, treatment of these
injuries can be complex and may have a significant impact on the
patient’s facial function and aesthetics.3
Management principles for soft tissue injuries in children are almost
similar as for the adults. In the case, initial wound care was started
with copious irrigation and debridement of the devitalized and necrotic
tissues. Wound repair was done in multiple layers. Absorbable 4/0 or 5/0
vicryl or polydioxanone sutures (PDS) is suitable for muscle and
subcutaneous tissue. Whereas, prolene/nylon 6/0 is the choice for skin
approximation.4
The cheeks are by surface area the largest subunit of the face. This
size correlates with a high frequency of injury to the cheek and the
underlying structures.3 Parotid duct injury should be
considered in any deep injuries to the cheek area located inferior to a
line extending from the tragus to the upper lip. Early detection and
repair of the ductal injuries is strongly advised since complications
from delayed identifications are challenging. The signs of unrecognized
parotid duct injury can be erythema, edema, sialocele, and tenderness
after uneventful soft tissue repair.5
Post-traumatic salivary fistulas, sialoceles or leakages are initially
managed with conservative treatment which includes pressure dressing,
needle aspiration, and administration of broad spectrum antibiotics. A
series by Lewis and Knottenbelt 6 concluded
that conservative management was adequate for parotid duct injuries.
Similarly, Landau and Stewart 7 concluded that
systemic probanthine, intravenous fluids, a nil by mouth regimen, and
external pressure would produce resolution of symptoms, even in the
presence of a fistula or sialocele. In the current case also,
re-suturing at the drainage site followed by pressure dressing for one
week brought about the favorable result.
The present case also raised our attention towards the mishaps from the
electronic wastes. Hence, preventive measures and education to the
individual, parents and society on a whole regarding the etiologies of
trauma in children and the proper disposal of E-wastes becomes very
crucial.