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.