Provider Prepared’s Weekly Pearl of Wound Wisdom #31 Its Cheeky!
A 40 year old male presents to the emergency department for evaluation of a cheek laceration, which occurred when he was struck in the face by a piece of aluminum rain gutter while doing exterior finish work on a home he is building.
As with all facial lacerations, cheek lacerations should have careful examination. When deep tissues of the cheek are involved, examination must include assessment for injury to the parotid gland, parotid duct and facial nerve.
The anatomy of the deep structures of the cheek must be understood for proper evaluation. The parotid gland and facial nerve branches are just anterior to the ear, they are also superficial to the masseter muscle. Since these structures are superficial to the masseter muscle, they can easily be involved in lacerations of the cheek. The parotid duct extends from the gland to the intra-oral mucosa with the opening adjacent to the second molar. Parotid duct injury must be considered when deep tissue laceration is present. Injury to these deep structures requires specialty consultation.
Hollander, JU et al. Assessment and management of facial lacerations. UpToDate November 2017.
This patient was found to have wound extension into the parotid gland, we subsequently obtained consultation with our Maxilofacial Surgeon, who took the patient to the operating room.
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Nathan Whittaker, MD
- Brandon Durfee