Aesthetic, functional and psychological outcomes of traumatic facial soft tissue injuries over three months—a prospective observational study

Background: Facial soft tissue injuries are a relatively common cause of visits to hospital emergency rooms. Studies on the impact of traumatic facial injuries include bony injuries but exclude soft tissue injuries with few studies on the impact of these injuries. This study undertook a comprehensive assessment of aesthetic, functional, and psychological outcomes following traumatic facial soft tissue injuries and compared patient perspectives and physician assessments. Methods: A prospective observational study was conducted in the Department of Oral & Maxillofacial Surgery of Manipal College of Dental Sciences Mangalore with inclusion of consecutive patients who reported for the management of facial soft tissue injuries from December 2020 to December 2022. Injuries were categorized into contusion, abrasion, and laceration. Outcomes were aesthetic sequelae measured using Patient and Observer Scar Assessment Scale (POSAS), incidence of functional sequelae like nerve injuries, loss of hair, scar contracture and psychological sequelae measured using Trauma Screening Questionnaire (TSQ). Independent t-test was used to compare the difference between POSAS. Chi-square test was used to test the association of TSQ score at 1 and 3 months with age, gender and type of injury. P<0.05 was considered as statistically significant. Results: Of the 96 participants included in the study, 54 (56%) were males and 42 (44%) females. Mean age was 38±15 years (range, 17–87 years). Collision in road traffic accident was the commonest cause of injury 53 (55.2%). The highest incidence was lacerations 54 (56.3%) followed by abrasion 30 (31.3%) and contusion 12 (12.5%). The most injured facial subunit was forehead 25 (26%). Mean scar assessment scored by the patient at 1 week, 1 month and 3 months was 7.53±0.71, 5.09±0.67 and 3.43±0.61 respectively and by the observer 6.63±0.72, 4.72±0.59 and 2.95±0.66 respectively and these differences were statistically highly significant (P<0.001). Hypopigmentation, hyperpigmentation, and scar thickening (elements evaluated in POSAS) were aesthetic sequelae for lacerations, none for contusions, and hypopigmentation for abrasions. Scar contracture 3 (3.1%) and hair loss 7 (7.3%) were the residual functional outcomes at 3 months, in the eyelid and chin facial subunits respectively. Mean TSQ score at 1 month was 5.54±2.010, and 3 months 4.22±1.819 (P<0.001), with no difference in TSQ score between sexes, age or type of injury (P>0.05). Conclusions: Aesthetic sequelae were highest for lacerations. Patients’ self-perception of scarring was consistently worse than that of observers’, but overall score improved over 3 months. Scar contracture and hair loss were functional sequelae persisting beyond 3 months and risk of developing post-traumatic stress disorder is best evaluated after 3 months.