Facial lacerations - essential structures to know
Facial lacerations require more than haemostasis and closure. Identification of injuries to deeper functional structures determines repair technique, timing, need for specialist input and medicolegal/safeguarding actions.
The Royal College of Emergency Medicine (RCEM) specifically lists three structures clinicians must recognise in facial trauma: the parotid (Stensen’s) duct, the nasolacrimal drainage apparatus, and the facial nerve (and its peripheral branches).
This section summarises relevant anatomy, bedside assessment, clinical consequences, and clear referral triggers.
Learning objectives
- Recall the surface anatomy and typical wound locations at risk for the parotid (Stensen’s) duct, nasolacrimal apparatus (puncta/canaliculi/nasolacrimal duct) and extracranial facial nerve branches.
- Perform a focused bedside assessment to detect injury to each structure before local anaesthetic where feasible.
- Identify when to escalate to ENT/OMFS/plastics/ophthalmology or follow safeguarding pathways in children.
- Apply practical principles for analgesia and procedural sedation in children undergoing repair.
Anatomy, surface landmarks and bedside assessment
Parotid (Stensen’s) duct
- Anatomy and course: The duct emerges from the anterior parotid gland, runs superficially across the lateral masseter, then turns medially to pierce the buccinator and opens into the oral mucosa opposite the maxillary second molar.
- Surface landmark: A line from the anterior tragus toward the upper second molar approximates the duct; it crosses the masseter approximately 1-2 cm below the zygomatic arch.