When a patient receives disfiguring trauma to the face, which profession is call

[Stacker]

When a patient receives disfiguring trauma to the face, which profession is called upon the most? I've read conflicting answers that either ENT or plastics are the first, then its the OMFS.
I know that it depends on the area where the trauma occurred but is there a single profession that is in charge of the rest and has the most decision making power?

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[UVAbme2009]

Way too broad of a question to get an answer to.

If it occurred in a trauma, the trauma surgery team would be the primary.

 

[Stacker]

Way too broad of a question to get an answer to.

If it occurred in a trauma, the trauma surgery team would be the primary.

Oh, I see. Then, I really don't know what my question is.

 

[Stacker]

I think what I mean to say is, regardless of where the patient was admitted, which profession performs the most significant portion of non-life-threatening cosmetic surgery in the facial area? Would it be the OMFS?

 

[UVAbme2009]

Oh, I see. Then, I really don't know what my question is.

ENT and plastics are rarely the primary care providers for someone who is on an inpatient service.

I guess the best answer is that superficial wounds would be plastics. ENT would take most of everything else unless the trauma is too close to the eyes and ophthamology would take that.

 

[Siverhideo1985]

Interdisciplinary surgery team depending on the location, extent, and acuity of the injury as well as the surgical specialty skills of the complement of surgeons at the institution. Probably hard to predict specifics w/o specific examples of types of injuries.

 

[dr zaius]

Interdisciplinary surgery team depending on the location, extent, and acuity of the injury as well as the surgical specialty skills of the complement of surgeons at the institution. Probably hard to predict specifics w/o specific examples of types of injuries.

This.

As an anecdote I fractured my zygomatic buttress and crushed the wall of my maxillary sinus playing soccer a couple of years ago. In the ER I had a CT of my head and was referred immediately to an OMFS who took care of everything.

I had my first med school interview a week after surgery 😳

 

[DrBowtie]

Where I'm at, there is rotating facial call split between plastics, ENT, and OMFS. They will handle the majority of stuff that needs to occur urgently. If there is very specific stuff that we have a specialist for like oculoplastics, they will temporize the situation and get it fixed in the AM.

 

[Siverhideo1985]

As an anecdote I fractured my zygomatic buttress and crushed the wall of my maxillary sinus playing soccer a couple of years ago. In the ER I had a CT of my head and was referred immediately to an OMFS who took care of everything.

Ouch. Very ouch.

 

[michaelrack]

Where I'm at, there is rotating facial call split between plastics, ENT, and OMFS. .

Institution dependent. The above arrangement is fairly typical; also just rotation between plastics and ENT.

 

[Stacker]

Ok thanks everyone. I understand now that although the skills of plastics, ENT, OMFS may overlap, all three profession have their own niche without a single profession trumping the rest.
So it's the institutions that determines when the use of each profession is specifically appropriate.

 

[lildave2586]

Ok thanks everyone. I understand now that although the skills of plastics, ENT, OMFS may overlap, all three profession have their own niche without a single profession trumping the rest.
So it's the institutions that determines when the use of each profession is specifically appropriate.

At my place ENT, plastics, and OMFS rotate face-call every third day. If you bust your face, you'll get fixed by whoever is on call that day. All three services pretty much can do the same things, but will ask for help from another service if they feel they need it.

 

[45408]

Where I'm at, there is rotating facial call split between plastics, ENT, and OMFS. They will handle the majority of stuff that needs to occur urgently. If there is very specific stuff that we have a specialist for like oculoplastics, they will temporize the situation and get it fixed in the AM.

That's what it's like here. I bet that if one specialty was willing to take it all, the other specialties would be happy to hand it over.

It's rare to be fighting over who gets the trauma patients. They're not a friendly, lucrative population that shows up during office hours!

If you want to do facial trauma, then you could probably pick any of these specialties, but my personal opinion is that ENT or OMFS would be the better choices. I don't think plastics is as well-suited to the facial fractures or oral injuries as the other two.

 

[flapaTron]

coming from the dental side to affirm what has already been said, it really is program dependent. some programs have the trio of PRS/ENT/OMFS, some only have OMFS taking ALL facial trauma call, some have no OMFS taking trauma call.

 

[ucsfstudents]

Usually its ENT, but it does depend on which service was on call that day (ENT vs OMFS). If you're trying to decide between ENT vs Plastics, I would go with ENT (if you want to fix facial trauma).

 

[isoquin]

Remember, ophthalmology and ENT have their own plastics subspecializations. I agree with the above though. Trauma will always stabilize the patient, but anyone who regularly works on the face can perform the final cosmesis, depending on area and damage.

 

[SouthernSurgeon]

Agree with all the above, although I would say that at my institution, regardless of which service is "on call" for facial trauma, if it is something truly complex our trauma surgeons have a couple of preferred attendings that they will just directly contact.

 

[VisionaryTics]

That's what it's like here. I bet that if one specialty was willing to take it all, the other specialties would be happy to hand it over.

It's rare to be fighting over who gets the trauma patients. They're not a friendly, lucrative population that shows up during office hours!

If you want to do facial trauma, then you could probably pick any of these specialties, but my personal opinion is that ENT or OMFS would be the better choices. I don't think plastics is as well-suited to the facial fractures or oral injuries as the other two.

ENT and OMFS split facial trauma call at my institution, and love each other as a result. They kind of resent plastics for not taking trauma call.

I saw a huge mandibular/Lefort I/ZMC fracture case that was handled jointly by ENT/OMFS. Plastics was not consulted.

 

[DREDAY]

Here is your answer:

Results

Information was obtained from 57 (75%) level-1 trauma hospitals. The remaining 19 (25%) hospitals failed to respond to our survey. The distribution of facial trauma coverage by the different specialties was as follows: plastic surgeons, 39.6%; oral and maxillofacial surgeons, 36.6%; otolaryngologists/head and neck surgeons, 23.3%; and other services (general surgery and oculoplastics), 0.5%. According to the respective professional societies contacted, there are approximately 7,003 plastic surgeons, 6,377 oral and maxillofacial surgeons, and 7,720 head and neck surgeons that are practicing members of their respective societies.


Reference:

Facial Trauma Coverage Among Level-1 Trauma Centers of the United States

Shahrokh C. Bagheri, DMD, Matt Dimassi, Abtin Shahriari, DMD, MPH, H. Ali Khan, DMD, MD, Chris Jo, DMD, Martin B. Steed, DDS