Do Children with Facial Hematomas Always Need Surgery? Exploring Alternatives

Does a child with a hematoma on the zygomatic bone always require surgery?

Hello, Doctor! On December 21, 2008, I took my son to a company year-end party, and on the way back, he was hit by a taxi near the company.
My son sustained injuries to his right eyelid and right cheek.
It has been almost a month now, and the swelling on his right cheek has not improved.
On January 15, 2009, I first took him to see an orthopedic specialist, who then referred us to the plastic surgery department at Shin Kong Hospital.
X-rays showed that there were no issues with the bones, but the swelling might be due to a hematoma.
The doctor mentioned that it should normally resolve within two weeks, but since it hasn't improved, it seems unlikely to go away now.
Furthermore, there is a concern that the hematoma may be starting to fibrose, as the area feels a bit firm to the touch.
The doctor has scheduled a CT scan for next week and mentioned that if we want to reduce the swelling, surgery (under general anesthesia) would be the only option.
I asked if surgery is absolutely necessary, and he said that no one knows if the swelling will eventually resolve on its own or continue to fibrose, nor can he predict the rate of fibrosis.
If we choose not to have surgery and the swelling does fibrose, it could lead to a depression in the area if we later decide to have the fibrous tissue removed.
I am unsure of what to do.
I would like to ask the doctor if surgery is really necessary, or if there are alternative ways to manage this situation.
Thank you!

HONEY, 30~39 year old female. Ask Date: 2009/01/17

Dr. Zhou Hongzhang reply Plastic Surgery

Generally speaking, if a hematoma is too large or has not resolved over time, surgical intervention may be considered.
The decision to perform surgery or not primarily depends on the following factors: 1.
Whether the ruptured blood vessels are small vessels, arteries, or capillaries at the time of injury? 2.
Is the patient's coagulation function normal? 3.
Has the patient applied ice or heat after the injury? 4.
Other relevant factors.
It is difficult to determine how to manage each case; a thorough consultation with the patient is necessary to decide on the subsequent medical treatment.

Reply Date: 2009/01/17

More Info

When it comes to managing facial hematomas in children, the decision to proceed with surgery is not always straightforward. In your case, your son has sustained a facial injury that has resulted in a hematoma, which has not resolved after a month. This situation raises several important considerations regarding the necessity of surgical intervention and the potential for alternative treatments.

Firstly, it is essential to understand that hematomas are collections of blood outside of blood vessels, typically caused by trauma. In many cases, especially in children, small hematomas can resolve on their own without the need for surgical intervention. The body has a remarkable ability to reabsorb blood and heal over time. However, the duration and size of the hematoma, as well as the presence of symptoms such as pain or functional impairment, can influence the treatment approach.

In your son's case, the hematoma has persisted for a month, which is longer than the typical resolution period of two weeks. The concern about potential fibrosis (the formation of excess fibrous connective tissue) is valid, as prolonged hematomas can lead to complications such as scarring or deformity. If the hematoma is indeed becoming fibrotic, it may not resolve on its own, and surgical intervention could be necessary to prevent further complications.

The recommendation for surgery, particularly under general anesthesia, is often based on the size of the hematoma, the degree of discomfort it causes, and the potential for aesthetic or functional issues in the future. If the hematoma is large and causing significant swelling or pressure, or if it is suspected to be evolving into a fibrous mass, surgery may be the best option to remove the hematoma and prevent further complications.

However, before proceeding with surgery, it is crucial to explore all available alternatives. Non-surgical options may include:
1. Observation: If the hematoma is not causing significant symptoms, a period of observation may be warranted. Regular follow-up appointments can help monitor the hematoma's progress.

2. Compression: Applying gentle compression to the area may help reduce swelling and promote reabsorption of the hematoma.

3. Medication: In some cases, medications such as anti-inflammatory drugs may be prescribed to alleviate discomfort and reduce swelling.

4. Aspiration: If the hematoma is large and causing significant symptoms, a healthcare provider may consider aspirating the hematoma using a needle and syringe. This procedure can relieve pressure and may allow for quicker healing without the need for full surgical intervention.

5. Physical Therapy: If there are functional limitations due to the hematoma, physical therapy may be beneficial in restoring normal movement and function.

Ultimately, the decision to proceed with surgery should be made in consultation with a qualified healthcare provider who can assess your son's specific situation. It is essential to weigh the risks and benefits of surgery against the potential for spontaneous resolution. If you have concerns about the necessity of surgery, seeking a second opinion from another pediatric specialist or a pediatric plastic surgeon may provide additional insights and options.

In conclusion, while surgery may be necessary in some cases of persistent facial hematomas, it is not always the only option. Exploring alternatives and discussing them with your healthcare provider can help ensure that your son receives the most appropriate care for his condition.

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