Radiation injuries of the maxillofacial region

Local treatment of thermal facial burns and plastic surgery

In deep facial burns, primary and early necrotomy are not used. Successful engraftment of a free skin graft requires excision of necrotic masses down to absolutely healthy tissues, which is impossible in the maxillofacial area without the risk of facial nerve damage and severe deformation. The wound is prepared for closure gradually, using oil-balsamic dressings and UV irradiation after scabbing detaches.

Criteria for wound readiness for autodermatoplasty include complete cleansing from necrosis, absence of pus, the appearance of fine-grained pink granulations, and a narrow border of epithelium at the edges. The graft is harvested with a dermatome from other parts of the body. An important rule: only continuous grafts without perforations are used, as holes irreversibly impair the aesthetic result.

For eye injuries (grades I–II), a 1% procaine solution, 30% albucid, and eye ointments are used. The survival prognosis of adult patients is assessed by the "Rule of Hundreds": if the sum of age and burn area is 60 or less — the prognosis is favorable, and at values of 101 and higher — unfavorable.

Electrical injury of the maxillofacial region

Damage from electric current depends on tissue resistance. Dry skin has a resistance of up to 2,000,000 ohms, but when moistened, it drops to 1,000 ohms, which critically increases the strength of the passing current. Local manifestations on the face ("current marks") look like dry, painless, whitish-gray areas protruding above the skin without surrounding edema.

Two types of current action are distinguished:

1. Nonspecific — burns from a voltaic arc flash (electric ophthalmia), barotrauma (rupture of the tympanic membrane), and mechanical injuries during a fall.
2. Specific, which includes:
3. Biological: ventricular fibrillation, vocal cord spasm, sharp catecholamine surge.
4. Electrochemical: coagulation necrosis at the anode (+) and liquefaction necrosis at the cathode (-).
5. Thermal: heating of tissues with low resistance (bone, skin) up to 4000 °C. The resulting carbonization paradoxically acts as an insulator, reducing the severity of overall trauma.
6. Mechanical: tissue rupture and delamination due to explosive energy release.

Electrical facial burns are usually deep: the area of muscle and cellular tissue destruction significantly exceeds the visible skin defect. Regeneration is sharply slowed, and by the 3rd–4th week, the risk of erosive bleeding is high.

Facial frostbite: clinical presentation and degrees

Cold injury spreads not across the surface, but deep into the tissues. On the face, the nose, auricles, and cheeks are most frequently affected. The pathological process proceeds in two periods: prereactive (tissue hypothermia with pallor and anesthesia) and reactive (after warming, when vascular thrombosis leads to necrosis).

There are 4 degrees of severity:

• Grade I: reversible changes, cyanosis, edema, pain, and burning. Resolves within a week with skin peeling.
• Grade II: death of the epidermis with the formation of blisters filled with yellowish exudate. The exposed dermis is sharply painful. Epithelialization takes 10–15 days.
• Grade III: total skin necrosis. Blisters contain hemorrhagic fluid. A black scab forms, and the demarcation line appears in 6–7 days. Heals with scarring.
• Grade IV: soft tissue death with exposure or involvement of bones.

In the prereactive period, light massage with a soft fabric and the application of an insulating dressing are indicated. Rubbing the face with snow is strictly prohibited — this increases hypothermia and injures the skin with ice crystals.

Providing care and medical triage

At the stage of qualified medical care (OMEdB) during mass casualties, victims are divided into four sorting groups:

1. Needing urgent care: patients in shock or with asphyxia (respiratory tract burn). With increasing respiratory failure and fading cough reflex, tracheostomy is indicated.
2. Eligible for evacuation: severely burned patients are sent to specialized hospitals. In combined trauma, routing depends on the primary lesion.
3. Lightly burned: patients with superficial wounds or deep burns up to 5% of the body surface, capable of moving independently.
4. Lightly injured: treated in the convalescent team (up to 10 days).

All victims are administered analgesics (promedol 2%, analgin 50%), antihistamines (diphenhydramine, pipolfen), tetanus toxoid, and antibiotics. In the absence of vomiting, oral rehydration with saline solutions or protein fruit drinks is performed.

Class and exam questions

What else to study on this topic

• Composition of oral rehydration solutions for burn shock
• Prevention and surgical treatment of acute chondritis of the auricle
• Differential diagnosis of grade III and IV frostbite in the reactive period
• Pathogenesis of late erosive bleeding after facial electrical injuries
• Management features of patients with a Filatov stalk under low temperature conditions

Other topics in the section "Chapter 11. Non-ballistic and ballistic facial injuries. Thermal and radiation lesions of the maxillofacial region (V.V. Afanasyev)"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.