Soft tissue injuries of the head and neck

Last updated: December 6, 2023

Summarytoggle arrow icon

Soft tissue injuries of the head and neck are usually caused by blunt or penetrating trauma and require careful clinical assessment. Imaging may be required to rule out fractures and other complications. Initial management of all head and neck injuries follows the Advanced Trauma Life Support (ATLS) protocol and includes addressing life-threatening conditions, such as airway compromise and bleeding. Once initial management has been concluded and complications have been ruled out, open head and neck wounds are managed similarly to other acute open wounds.

For other soft tissue injuries of the neck, see also “Neck sprains,” “Blunt neck injuries,” and “Penetrating neck injuries.”

Etiologytoggle arrow icon

Approachtoggle arrow icon

Follow the ATLS algorithm in any patient with suspected severe head injury.

Significant trauma [2][3]

Red flags for a difficult airway include oropharyngeal bleeding, expanding hematomas, and/or significant distortion of the mouth, oropharynx, and/or upper neck. [5]

Open wounds [5][6][7]

Obtain specialist consult for any wound complicated by fractures, damage to subdermal structures (e.g., cranial nerves, glands, ducts), or significant cosmetic or functional impairment. [5]

All patients

Wound managementtoggle arrow icon

For basic principles of wound care, see “Management of open wounds.” See sections on “Facial wounds,” “Scalp lacerations,” and “Neck wounds” for specific considerations.

Hemostatic measures [6][7][8]

Wound irrigation and debridement

Anesthesia and supportive care

Wound closure


  • Nonabsorbable facial sutures are typically removed after 3–5 days.
  • See also “Follow-up” in “Management of open wounds.”

Facial woundstoggle arrow icon

Eyebrow lacerations [5][6][7]

  • Examine sensory functions of the supraorbital and supratrochlear nerves. [6]
  • Perform layered wound closure.
    • Repair deep muscular layers to preserve the expressive function of the brow.
    • Repair the skin while avoiding inversion of hair-bearing skin into the wound.

Do not shave eyebrows, as eyebrow hair is an important landmark for correct reapproximation and regrowth is unpredictable. [5][7]

Cheek lacerations [5][6]

Open wounds of the mouth [5][6][7]

Lip lacerations [5][6]

Do not use tissue adhesive to repair lip lacerations. [5]

Oral mucosa and tongue lacerations [5][7]

Small superficial tongue lacerations rarely require repair. [5][7]

Other anatomic locations [5]

Scalp lacerationstoggle arrow icon

For scalp lacerations with underlying contusions or skull fractures, see also “Open head injuries” and “Traumatic brain injury.”

General measures [5][8]

Scalp lacerations can cause significant blood loss. In polytrauma, heavy scalp bleeding can be quickly controlled with staples or a tight dressing.

Use caution when manipulating scalp wounds with suspected underlying skull fractures to avoid pushing comminuted or depressed bone into the skull.

Hair apposition technique [7][15][16]

  • Definition: a technique for primary closure of scalp wounds using strands of hair and tissue adhesive
  • Indications: simple, superficial scalp wounds suitable for primary closure in adults and children
  • Contraindications: actively bleeding, contaminated, or complex scalp wounds
  • Procedure: For pitfalls and postprocedural concerns, see also “Tissue adhesive.”
    1. Grasp several strands of hair from opposite sides of the wound using hemostats or gloved fingers.
    2. Cross and interlock the strands over the wound with a 180° or 360° twist without knotting the hair.
    3. Apply a drop of tissue adhesive over the base of the twist and allow it to dry.
    4. Repeat steps every 1–2 cm along the entire wound.

Neck woundstoggle arrow icon

Suspect injuries to deeper structures of the neck if there are any soft or hard signs of penetrating neck injury (e.g., hemoptysis or subcutaneous emphysema), evidence of neurovascular injury, or violation of platysma.

Referencestoggle arrow icon

  1. Tintinalli JE, Stapczynski JS, Ma OJ, Yealy D, Meckler GD, Cline DM. Tintinalli's Emergency Medicine: A Comprehensive Study Guide, 9th edition. McGraw Hill Professional ; 2019
  2. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine 10th edition- Concepts and Clinical Practice E-Book. Elsevier Health Sciences ; 2022
  3. Cho DY, Willborg BE, Lu GN. Management of Traumatic Soft Tissue Injuries of the Face. Semin Plast Surg. 2021; 35 (04): p.229-237.doi: 10.1055/s-0041-1735814 . | Open in Read by QxMD
  4. Roberts JR. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. Elsevier ; 2018
  5. Hock MOE, Ooi SBS, Saw SM, Lim SH. A randomized controlled trial comparing the hair apposition technique with tissue glue to standard suturing in scalp lacerations (HAT study). Ann Emerg Med. 2002; 40 (1): p.19-26.doi: 10.1067/mem.2002.125928 . | Open in Read by QxMD
  6. Ozturk D, Sonmez BM, Altinbilek E, et al. A retrospective observational study comparing hair apposition technique, suturing and stapling for scalp lacerations. World J Emerg Surg. 2013; 8 (1).doi: 10.1186/1749-7922-8-27 . | Open in Read by QxMD
  7. American College of Surgeons and the Committee on Trauma. ATLS Advanced Trauma Life Support. American College of Surgeons ; 2018
  8. Truong T. Initial Assessment and Evaluation of Traumatic Facial Injuries. Semin Plast Surg. 2017; 31 (02): p.069-072.doi: 10.1055/s-0037-1601370 . | Open in Read by QxMD
  9. Patel A, Saadi R, Lighthall JG. Securing the Airway in Maxillofacial Trauma Patients: A Systematic Review of Techniques. Craniomaxillofac Trauma Reconstr. 2020; 14 (2): p.100-109.doi: 10.1177/1943387520950096 . | Open in Read by QxMD
  10. Kouba DJ, LoPiccolo MC, Alam M, et al. Guidelines for the use of local anesthesia in office-based dermatologic surgery. J Am Acad Dermatol. 2016; 74 (6): p.1201-1219.doi: 10.1016/j.jaad.2016.01.022 . | Open in Read by QxMD
  11. Ilicki J. Safety of Epinephrine in Digital Nerve Blocks: A Literature Review. J Emerg Med. 2015; 49 (5): p.799-809.doi: 10.1016/j.jemermed.2015.05.038 . | Open in Read by QxMD
  12. Hafner HM, Rocken M, Breuninger H. Epinephrine-supplemented local anesthetics for ear and nose surgery: Clinical use without complications in more than 10,000 surgical procedures. J Dtsch Dermatol Ges. 2005; 3 (3): p.195-199.doi: 10.1111/j.1610-0378.2005.04758.x . | Open in Read by QxMD
  13. Cline DM. Tintinalli's Emergency Medicine Manual 7th Edition. McGraw Hill Professional ; 2012
  14. Nicks BA, Ayello EA, Woo K, Nitzki-George D, Sibbald RG. Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations. Int J Emerg Med. 2010; 3 (4): p.399-407.doi: 10.1007/s12245-010-0217-5 . | Open in Read by QxMD
  15. Childs DR, Murthy AS. Overview of Wound Healing and Management. Surg Clin North Am. 2017; 97 (1): p.189-207.doi: 10.1016/j.suc.2016.08.013 . | Open in Read by QxMD
  16. Maricevich R, Braun T. Soft Tissue Management in Facial Trauma. Semin Plast Surg. 2017; 31 (02): p.073-079.doi: 10.1055/s-0037-1601381 . | Open in Read by QxMD

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