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

Summary

In a randomized trial of 162 emergency patients, landmark-based nerve blocks reduced anesthetic volume and pain, preserved facial topography, and improved 3-month POSAS scores versus local infiltration. Anatomical landmark maintenance, subunit symmetry, and junction alignment were all superior with nerve blocks.

Key Findings

• Anesthetic volume was reduced with nerve blocks (2.03 ± 0.82 mL) vs infiltration (4.94 ± 1.71 mL), p < 0.001.
• Lower pain scores with nerve blocks (median 2) vs infiltration (median 5), p < 0.001.
• Improved preservation of facial topography (0.6 ± 0.5 vs 1.8 ± 0.7, p < 0.001) and better landmark maintenance (96.3% vs 88.4%, p = 0.02).
• Higher aesthetic subunit symmetry (94.8% vs 87.2%, p = 0.03) and cosmetic junction alignment (95.5% vs 86.9%, p = 0.02); 3-month POSAS favored nerve blocks (p < 0.01).

Clinical Implications

Prefer landmark-based regional nerve blocks for complex facial lacerations to reduce tissue distortion and improve scar quality. Train ED teams on zygomaticofacial/zygomaticotemporal blocks and incorporate POSAS-based follow-up.

Limitations

• Single-center study; external validity may be limited.
• Short follow-up (3 months); long-term scar maturation not assessed; potential learning-curve effects for certain blocks.

Future Directions

Multicenter, longer-term RCTs evaluating 6–12 month scar outcomes, cost-effectiveness, and standardized training protocols for regional blocks in emergency settings.