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

Abstract

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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Keywords: Emergency plastic surgery; Esthetic units; Facial trauma; Local anesthesia; Nerve block; Surgical precision.