Multiple midface degloving injury in an elderly man: challenges and management outcome

We present a case of multiple degloving injuries in an elderly man following a fall from a palm tree. Multiple midface injuries are very rare, although individual types have been reported. Our patient sustained injuries in the lower and middle thirds of the face, including multiple tongue lacerations and a deep jagged laceration at the lower posterior part of the neck with a piece of wood in place. The facial degloving injury in this case posed an immediate danger from disruption of the respiratory system and hemorrhage. Emergency care involved prevention of respiratory embarrassment through a tracheostomy, maintenance of hemostasis and wound contamination. All the bone fractures were immobilized using interosseous wires and the avulsed nasal cartilage was immobilized with polyglactin 910 sutures against the anterior nasal spine. This case was unique because it was possible to manage the various challenges and significant risk to life by emergency tracheostomy and adoption of a multidisciplinary approach.