Complex Cheek and Lip Avulsion with Layered Facial Reconstruction
Independent repair of a motor vehicle collision—related cheek and upper lip avulsion with assessment of parotid duct and facial nerve branches, and layered closure restoring oral competence.
Patient Information
- Age: 26 years
- Gender: Female
- Diagnosis: Full-thickness cheek and upper lip avulsion with tissue loss and contamination after road traffic accident
Procedure
Emergency débridement, facial nerve and parotid duct assessment, three-layer closure (mucosa, muscle, skin), and alignment of vermillion border and modiolus.
Findings
Through-and-through defect of upper lip and lateral cheek measuring approximately 6 × 4 cm composite loss with adjacent abrasions. Bleeding controlled; no condylar fracture on CT. Facial nerve function grossly intact pre-block; parotid duct identified transected at buccal level. Wound heavily contaminated—copious washout performed.
Surgical Technique
Non-viable tissue débrided. Parotid duct cannulated proximally with 24G catheter; distal segment located and duct repaired over stent with 7-0 Vicryl. Orbicularis oris and zygomaticus major reapproximated with 4-0 Vicryl. Vermillion border marked with surgical pen prior to any incision adjustment. Mucosal layer closed with 5-0 Vicryl; skin with 6-0 nylon simple interrupted, everted edges. No immediate flap required—tension distributed via undermining within cosmetic subunits.
Outcome
Wounds healed at 10 days; stent removed at 3 weeks with duct patency suggested by salivary flow. No wound infection. At 3 months, acceptable lip symmetry, oral competence preserved, and no symptomatic sialocele; mild hypertrophic scar managed with silicone sheeting.
Clinical Notes
Facial subunit alignment and duct repair were as important as skin closure for functional outcome. Suitable for before/after clinical photography when consented.