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Introduction
xiii
est costs, after hip fracture, among injuries. The total healthcare costs due to
injury in the study year (1999) were euro 1.15 billion with supercial injuries
accounting for 13% of the total amount. In another study, Polinder et al.
(2005) estimated the costs of injury-related hospital admissions in ten
European countries. They observed an exponential increase per capita in
older age groups (age >or= 65years) for all countries, due to the combined
effect of high incidence and high costs per patient. Mo etal. (2021) recently
reviewed the data of 3,634,229 people from Korea regarding facial lacerations. The authors’ ndings showed that their treatment costs increased substantially, more than ination rate, over a 3-year period (2014–2018) and
indicate that a greater economic burden is being imposed on patients and
caregivers due to usage of nonpayment dressing material and topical
ointments.
Facial injuries requiring plastic surgery are costly. It is interesting to note
that for minor injuries, the quality-of-life costs generally exceed the monetary costs (Miller etal. 1995). A lower incidence will probably reduce the
high cost of treatment of these injuries. Therefore, new strategies to reduce
the incidence of facial injuries need to be developed. At all times, however,
thorough knowledge of the anatomy and physiology of the facial structures,
the biomechanics of tissue injury, the molecular biology and biochemistry of
wound healing, the art of soft-tissue repair using meticulous techniques, and
a conscientious follow-up are of great importance regardless of whether A&E
doctors or surgeons treat such injuries. Furthermore, a successful triage of the
difcult and complex cases and their referral to a specialized facial surgeon
(plastic surgeon, specialized oral and maxillofacial surgeon, specialized ENT
surgeon) will warrant the best possible treatment and a good end result.
Failure seems to arise more often than not from the inability to recognize the
extent of an injury, rather than from the inability to treat the recognized injury
(Bhattacharya 2012).
References
Bernstein E, Pathak D, Rutledge L, etal. New Mexico safety restraint law:
changing patterns of motor vehicles injury, severity and cost. Am J Emerg
Med. 1989;7:271–7.
Bhattacharya V.Management of soft tissue wounds of the face. Indian J Plast
Surg. 2012;45:436–43.
Corso P, Finkelstein E, Miller T, etal. Incidence and lifetime costs of injuries
in the United States. Inj Prev. 2006;12:212–8.
Hill CM, Eppley BL, Thomas DW, etal. Etiology and prevention of maxil-
lofacial trauma. In: Ward Booth P, Eppley B, Schmelzeisen R, editors.
Maxillofacial trauma and esthetic facial reconstruction. Elsevier; 2010.
Kraft A, Abermann E, Stigler R, etal. Craniomaxillofacial trauma: synopsis
of 14,654 cases with 35,129 injuries in 15 years. Craniomaxillofac Trauma
Reconstr. 2012;5:41–50.
Kretlow JD, McKnight AJ, Izaddoost SA.Facial soft tissue trauma. Semin
Plast Surg. 2010;24:348–56.
Meerding WJ, Mulder S, van Beeck EF.Incidence and costs of injuries in the
Netherlands. Eur J Public Health. 2006;16:272–8.
xiv
Miller TR, Pindus NM, Douglas JB, etal. Databook of non-fatal injury: inci-
dence, costs and consequences. Washington DC: The Urban Institute
Press; 1995.
Mo YW, Cho GY, Mo YT, etal. National level data analysis of facial lacera-
tions in Korea using the National Health Insurance Service (NHIS) database. Medicine (Baltimore). 2021;100:e24163.
Ong TK, Dudley M.Craniofacial trauma presenting at an adult accident and
emergency department with an emphasis on soft tissue injury. Injury.
1999;30:357–63.
Otterness K, Thode HC Jr, Singer AJ. Methods of laceration closure in the
ED: a national perspective. Am J Emerg Med. 2020;38:1058–61.
Perkins CS, Layton SA.The aetiology of maxillofacial injuries and the seat
belt law. Br J Oral Maxillofac Surg. 1988;26:353–63.
Polinder S, Meerding WJ, van Baar ME, etal. Cost estimation of injury-
related hospital admissions in 10 European countries. J Trauma.
2005;59:1283–90.
Ste-Marie-Lestage C, Adler S, St-Jean G, etal. Complications following chin
laceration reparation using tissue adhesive compared to sutures in children. Injury. 2019;50:903–7.
Yamamoto R, Homma K, Masuzawa Y, etal. Early complications following
facial laceration repair performed by emergency physicians after one year
of wound closure training. AEM Educ Train. 2018; 2:259–68.
Introduction
Contents
1 Importance of Normal and Scarred Facial Appearance . . . . . . . 1
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2 Epidemiology of Soft-Tissue Injuries of the Head and Neck . . . 5
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
3 General Principles of Wound Management . . . . . . . . . . . . . . . . . 9
3.1 Principles of Patient Management . . . . . . . . . . . . . . . . . . . . . . 9
3.2 Wound Preparation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.3 Suturing Technique . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
3.4 Hematomas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
3.5 Abrasions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
3.6 Avulsions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
3.7 Penetrating Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
3.8 Gunshot Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
4 Injuries of the Scalp, Forehead, and Eyebrow . . . . . . . . . . . . . . . 31
4.1 Anatomy of the Scalp, Forehead, and Eyebrow . . . . . . . . . . . . 31
4.2 Scalp Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
4.3 Forehead and Eyebrow Injuries . . . . . . . . . . . . . . . . . . . . . . . . 36
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
5 Injuries of the Eyelids, Canaliculi, and Canthi . . . . . . . . . . . . . . 41
5.1 Anatomy of the Eyelids, Lacrimal System, and Canthi . . . . . . 41
5.2 Eyelid and Canalicular Lacerations . . . . . . . . . . . . . . . . . . . . . 44
5.3 Medial and Lateral Canthus Lacerations . . . . . . . . . . . . . . . . . 50
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
6 Injuries of the Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
6.1 Anatomy of the Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
6.2 Diagnosis of Nasal Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
6.3 Septal Hematoma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
6.4 Nasal Lacerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
6.5 Bite Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
7 Injuries of the Cheek . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
7.1 Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
7.2 Parotid Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
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xvi
7.3 Parotid Duct Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
7.4 Facial Nerve Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
7.5 Cheek Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
8 Injuries of the Lips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
8.1 Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
8.2 Lacerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
8.3 Avulsions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
8.4 Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
9 Injuries of the Ears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
9.1 Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
9.2 Auricular Hematoma, “Cauliower Ear” . . . . . . . . . . . . . . . . . 86
9.3 Lacerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88
9.4 Avulsions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
9.5 Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
10 Injuries of the Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
10.1 Anatomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
10.2 Blunt and Penetrating Injuries to the Neck . . . . . . . . . . . . . . 98
10.3 Injuries to the Air Passages . . . . . . . . . . . . . . . . . . . . . . . . . . 99
10.4 Vascular Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
10.4.1 Blunt Extracranial Carotid Injuries . . . . . . . . . . . . . 105
10.4.2 Penetrating Extracranial Carotid Injuries. . . . . . . . . 107
10.5 Injuries of the Pharynx and the Esophagus . . . . . . . . . . . . . . 109
10.6 Neurologic Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
10.7 Thyroid and Submandibular Gland Injuries. . . . . . . . . . . . . . 112
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Contents
11 Burns of the Scalp, Face, and Neck . . . . . . . . . . . . . . . . . . . . . . . . 119
11.1 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
11.2 Minor Burns: Ambulatory Treatment . . . . . . . . . . . . . . . . . . . 124
11.3 Moderate and Severe Burns . . . . . . . . . . . . . . . . . . . . . . . . . . 131
11.4 Surgical Wound Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
11.5 Perioral Burns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
11.6 Eyelids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
11.7 Eyebrows . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
11.8 Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
11.9 Scalp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
11.10 Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
11.11 Ears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
11.12 Long-Term Sequelae of Burns . . . . . . . . . . . . . . . . . . . . . . . . 149
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149
12 Wound Healing Disturbances: The Unfavorable Result . . . . . . . 155
12.1 Phases of Wound Healing . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
12.1.1 Hemostasis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Contents
xvii
12.1.2 Inammation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
12.1.3 Proliferation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
12.1.4 Remodeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156
12.2 Mechanisms of Wound Healing . . . . . . . . . . . . . . . . . . . . . . . 157
12.3 Pathologic Responses to Wound Healing . . . . . . . . . . . . . . . 158
12.3.1 Hypo- and Hyperpigmentation . . . . . . . . . . . . . . . . 158
12.3.2 Hypertrophic Scars, Keloids, and Contractures . . . . 159
12.3.3 Other Scar Problems . . . . . . . . . . . . . . . . . . . . . . . . 165
12.4 Complications of Specic Anatomical Areas . . . . . . . . . . . . 170
12.4.1 Scalp . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
12.4.2 Eyebrow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170
12.4.3 Eyelids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
12.4.4 Canthus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
12.4.5 The Lacrimal System . . . . . . . . . . . . . . . . . . . . . . . . 174
12.4.6 Nose . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175
12.4.7 Lips . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177
12.4.8 Neck . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179
Index ..................................................... 185
About the Author
Charilaos A. Ioannidis is a former Assist. Professor at the Radboud
University of Nijmegen (former Katholieke Universiteit Nijmegen), the
Netherlands. He was appointed Assoc. Professor of Surgery (Head & Neck
Surgery) at the University of Leuven (Katholieke Univesiteit Leuven),
Belgium (1991), and later Consultant at the Department of Plastic and
Reconstructive Surgery, the Middlesex Hospital, University College London
Hospitals NHS Trust, and honorary consultant, the Whittington Hospital
(1996), London, Great Britain. Since 2002 he has been practicing plastic and
reconstructive surgery as a consultant plastic surgeon in Athens, Greece.
Besides trauma (head and neck, hand, soft tissues), his special elds of interest include head and neck surgery, skin cancer (melanoma and nonmelanoma), soft tissue tumors, breast surgery (congenital deformities, oncology),
reconstructive surgery (microsurgery), necrotic soft tissue infections, and
aesthetic surgery.He is, or has been, a member of numerous international scientic societies and associations, as well as numerous non-prot organizations. He is a fellow of the European Board of Cranio- Maxillofacial Surgery
(FEBCMFS). He was awarded the Leibinger Prize of the European
Association of Cranio-Maxillofacial Surgery for his experimental work on
cartilage transplants (1988) and numerous medals and decorations for his
scientic and clinical work.Dr. Ioannidis has published over seventy-ve scientic papers in peer-reviewed national and international journals, as well as
four books. He has also published numerous articles in newspapers and magazines on plastic surgery, skin cancer, breast pathology, facial traumatology,
and other topics. He is a member of the editorial board of the Journal of
Cranio-Maxillofacial Surgery (he has also served as section editor for the
same journal). In addition, he has served as a reviewer for various other international surgical journals.
xix
Importance ofNormal andScarred
Facial Appearance
1
Vultus est index animi (The face is the index of
the soul—Latin proverb). A good face is a letter
of recommendation (Joseph Addison, 1672–
1719). Truth exists for the wise, beauty for the
feeling heart (Friedrich Schiller, 1759–1805,
Don Carlos).
These are some ways to describe how important aspect of our phenotype our face is. So
important that facial recognition is one of many
innate, reexive, cognitive competencies.
The face is the “organ of emotion.” One constantly reads other people’s facial expressions to
understand what they feel. Our faces are a
dynamic canvas, one in which emotions are
drawn vividly and then suddenly craved, only to
be redrawn in a new expression an instant later.
The face contains other powerful clues as well.
Our identity is captured in our facial features.
Our eyes reveal, often, important truths about us.
Our face also plays a role in physical attractiveness (Langlois etal. 2000). The face is an important channel of identity. Our face develops as we
do, from infancy into adulthood, crossing into
middle age, and nally into the senior years,
always retaining features already prominent in
childhood. We constantly monitor the face,
because it provides vital clues to an impressive
variety of possibilities: attraction, whether
another person likes or dislikes us, complexity of
emotions, identity, age, humor, and a person’s
regional and even national background. Facial
attractiveness and body weight seem to be the
best predictors of overall physical attractiveness
(Swami etal. 2007).
Evolutionary and socialization theory suggests that human facial appearance and attractiveness in particular inuence the perception of
others in social interactions, as well as development of certain behaviors (e.g., social skills, dating) and traits (e.g., mental and physical health)
(Langlois etal. 2000; Hoss et al. 2005). Studies
have shown that people assign more positive
qualities to attractive children and adults than to
unattractive ones (Langlois etal. 2000; Mobius
and Rosenblat 2006). In addition, facial attractiveness correlates positively with mating success
and, thus, supports the hypothesis that the attractiveness of the face is important in human mate
selection (Rhodes et al. 2005). Moreover, people’s view of facial attractiveness seems to be
remarkably consistent, regardless of race, nationality, or age (Langlois etal. 2000). It is, therefore,
hardly surprising that humans attach great importance to a beautiful, healthy, and youthful- looking
skin cover and an intact face. The signicance of
the appearance of facial skin is also evident in
dermatologic disorders and scarring, which can
have a major impact on patients’ daily activities,
self-esteem, mental well-being, and social relationships because of their conspicuous visibility
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023
C. A. Ioannidis, Soft Tissue Injuries of the Head and Neck,
https://doi.org/10.1007/978-3-031-14915-3_1
1
2
1 Importance ofNormal andScarred Facial Appearance
(Barankin and De Koven 2002; Beattie and
Lewis-Jones 2006). Interestingly, a study of
patients from different social and ethnic groups
in South Africa revealed that women were more
likely than men to report the effects of skin disease on self-esteem, clothing choice, treatment
problems, and anxiety (Jobanputra and Bachmann
2000).
Social class and language group inuenced
the impact of skin disease on the overall quality
of life (QoL). Glynn etal. (2009) observed that
socioeconomically disadvantaged adults manifest negative psychological outcomes even 1year
after an orofacial injury. Poor social support and
unmet social service needs immediately after the
injury, as well as high post-traumatic stress disorder symptoms at 1month post-injury, are strongly
associated with the risk of developing chronic
post-traumatic stress disorder. Gender does not
seem to have a signicant impact on QoL and
psychology in patients with facial scars. A recent
study on 32 patients with facial burn scars showed
no statistically signicant difference in QoL
between males and females suffering from anxiety and depression (Kundu et al. 2021). There
was, however, a signicant relationship between
early depressive symptoms and both patient-rated
facial scar severity and subsequent self-esteem in
patients with facial burns, as was observed in
another study from the Netherlands (Hoogewerf
etal. 2014).
There is substantive evidence that an attractive
and normal facial appearance is central to the
development of normal peer relationships,
healthy personal adjustment, and success in
school and in an adult career (Speltz and Richman
1997; Pope and Ward 1997).
As the face is of particular importance in
human social communication (Haxby etal. 2002)
and body image (Coterill and Cunliffe 1997),
even minor imperfections can have an often disproportionately major impact on mental health
and quality of life.
A study by Abdullah etal. (1994) on children
(6–18years old) having suffered facial, neck, and
hand burns showed that as the number of scars
increased in those areas, the patient’s scores for
“physical appearance” and “happiness and satis-
faction” decreased (p < 0.001). Rumsey and
Harcourt (2007) in a more recent study reported
that disgurement can have considerable psychological ramications for children and adolescents. While many young people adapt to the
demands placed upon them and appear relatively
unaffected, others have difculties including
adverse effects on body image, quality of life,
self-esteem, and difculty with social
encounters.
Rankin and Borah (2003) investigated the
effect of post-trauma facial scars on social functionality. A ve-group comparative research
design rated the differences among ten examples
of digitally altered facial photographs of actual
patients among various age and ethnic groups
with “normal” and “abnormal” congenital deformities or post-trauma scars. Photographs of adult
patients with observable congenital and posttraumatic deformities (abnormal) were digitally
retouched to eliminate the stigmatic defects (normal). The normal and abnormal photographs of
identical patients were evaluated by a large sample study group (210 respondents) on nine parameters of social functioning using a visual analogue
rating scale. Patients with abnormal facial characteristics were rated as signicantly less honest
(p = 0.007), less employable (p = 0.001), less
trustworthy (p=0.01), less optimistic (p=0.001),
less effective (p=0.02), less capable (p=0.002),
less intelligent (p=0.03), less popular (p=0.001),
and less attractive (p = 0.001) than the same
patients with normal facial appearances. Adverse
perceptions of patients with facial deformities
caused by trauma, congenital disabilities, and
postsurgical sequelae occur regardless of sex,
educational level, and age of evaluator (Rankin
and Borah 2003).
Levine etal. (2005) from the Yale University
School of Medicine studied the social and psychologic impact of facial trauma on previously
healthy individuals. Inclusion criteria for the
study included 18- to 45-year-old individuals
who had a facial laceration of 3 cm or greater
and/or a fractured facial bone requiring operative
intervention within 6months to 2 years prior to
participation in the study. When compared with a
control population, the study group showed a sta-
References
3
tistically signicant lower satisfaction with life,
more negative perception of body image, higher
incidence of post-traumatic stress disorder,
higher incidence of alcoholism, and an increase
in depression. Also, among the study group, there
was a signicantly higher incidence of posttrauma unemployment, marital problems, binge
drinking, jail, and lower attractiveness scores.
This study showed that there is signicant negative social and functional impact related to facial
trauma and scarring.
Even minor post-traumatic facial scars can
have signicant psychological impact for some
people. Tebble et al. (2004) reviewed patients
with a visible facial laceration over 1.5cm that
was treated in an outpatient setting. The Derriford
Appearance Scale (with general and social selfconsciousness subscales) and the State-Trait
Anxiety Inventory were administered to 63
patients 1 week later; data on 50 patients were
also available 6months after the injury. Larger
scar size, living alone, and etiology of injury
were signicantly related to self-consciousness
and anxiety levels, although gender, age, socioeconomic group, location of scar, satisfaction
with appearance, and number of scars were not.
General self-consciousness improved at
6months, but social self-consciousness and anxiety remained the same. Patient factors were not
related to changes in general self-consciousness
over time (Tebble et al. 2004). In another more
recent study by Godoy etal. (2011), the authors
observed that the attractiveness penalty caused
by a facial lesion was correlated with size but not
location. In a study of burn patients from the
Dutch Burns Foundation, Beverwijk, Van Loey
and Van Son (2003) observed that facial disgurement was a risk factor related to depression.
Visibility of burn injury was a risk factor related
to post-traumatic stress disorder. In another study
of burn patients, Lawrence etal. (2004) reported
that the correlation between visible scarring and
different aspects of body esteem, that is, selfsatisfaction with appearance (-. 19) and perception of other reaction to your appearance (-. 27),
was statistically signicant but low. Visible scarring had a low but signicant correlation with
perceived stigmatization (-. 23) and was not correlated with depression.
Most people would like to go through life
unscarred because of the negative impact of an
unsightly, disguring facial scar on an individual’s life. On the other hand, many of those who
have scars would like to get rid of them. The
importance of proper surgical treatment of
facial and neck injuries cannot be stressed
enough. In that way, the patient will enjoy, at
least from the doctor’s point of view, the best
possible result, which will affect his/her life the
least or, preferably, not at all. If, however, an
unsightly scar is present, its correction will
undoubtedly improve the patient’s overall quality of life.
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