Aesthetic Unit Preservation in Emergency Facial Lacerations: A Prospective Evaluation of Landmark-Based Nerve Blocks.

BACKGROUND

Facial trauma repair requires precise reconstruction while preserving aesthetic units. Traditional local anesthesia can distort tissue planes and compromise surgical precision.

METHODS

This prospective study evaluated landmark-based nerve blocks versus local infiltration for complex facial laceration repair in emergency settings from January 2022 through February 2023. A total of 162 patients were randomized to receive either landmark-based nerve blocks (n = 80) or traditional local anesthesia (n = 82). The nerve block group received targeted injections at anatomical landmarks, while the control group received traditional wound margin infiltration.

RESULTS

The nerve block group demonstrated significantly reduced anesthetic volume (2.03 ± 0.82 mL vs. 4.94 ± 1.71 mL, p < 0.001), lower pain scores (median 2 vs. 5, p < 0.001), and better preservation of facial topography with reduced tissue distortion (0.6 ± 0.5 vs. 1.8 ± 0.7, p<0.001). Superior maintenance of anatomical landmarks (96.3% vs. 88.4%, p = 0.02), aesthetic subunit symmetry (94.8% vs. 87.2%, p = 0.03), and cosmetic junction line alignment (95.5% vs. 86.9%, p = 0.02) was observed in the nerve block group. Three-month POSAS scores showed better outcomes in the nerve block group for both observer and patient assessments (p < 0.01).

CONCLUSIONS

While some technical challenges exist with zygomaticofacial and zygomaticotemporal blocks, landmark-based nerve blocks represent an effective approach for complex facial laceration repair, offering improved surgical precision and patient comfort.

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