title: Management of Self-Harm Injuries in the Maxillofacial Region: A Report of 2 Cases and Review of the Literature.
abstract: Clinicians face numerous challenges when managing psychiatric patients who self-inflict injuries within the maxillofacial region. In addition to a complex clinical examination, there are both surgical and psychiatric factors to consider, such as the risk of damaging vital structures, the exacerbation of the patient's psychiatric status, and the long-term psychosocial and esthetic sequelae. We present 2 cases of adolescents who repeatedly self-inflicted wounds and/or inserted foreign bodies (FBs) into the face, scalp, and neck. The different treatment modalities were based on full evaluation of the patient's clinical, medical, and diagnostic test findings coupled with a psychiatric assessment. The decision for conservative management or surgical intervention was made according to the presence and location of the FBs, degree of hemorrhage, signs and symptoms of infection, and unpleasant scars that could lead to long-term psychological impairment. In most cases, the FBs were removed and the wounds were toileted and closed under local or general anesthesia. We advocate a holistic approach via a multidisciplinary team, which is deemed essential to provide the highest quality of care for patients to reduce the risk of further relapses. Lastly, a satisfactory esthetic outcome is always paramount to achieve long-term psychological and physical welfare.
authors.affiliation: Community Dental Officer, Derbyshire Community Health Services, Leicester, United Kingdom. Electronic address: egonzalezmalaga@gmail.com.
authors.forename: Elizabeth Gonzalez
authors.initials: EG
authors.lastname: Malaga
authors.affiliation: Specialist Training in Periodontics, Eastman Dental Institute, UCL, London, United Kingdom.
authors.forename: Eva Maria Muñoz
authors.initials: EM
authors.lastname: Aguilera
authors.affiliation: Dental Core Trainee, OMFS Department, Luton and Dunstable University Hospital, Luton, United Kingdom.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Eaton
authors.affiliation: Consultant in Oral and Maxillofacial Surgery, OMFS Department, Northampton General Hospital, Northampton, United Kingdom.
authors.forename: Phillip
authors.initials: P
authors.lastname: Ameerally
mesh_terms: D000293:Adolescent; D005145:Face / Q000000981:diagnostic imaging / Q000601:surgery; D005260:Female; D005547:Foreign Bodies / Q000000981:diagnostic imaging / Q000601:surgery; D006257:Head / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008437:Maxilla / Q000000981:diagnostic imaging / Q000601:surgery; D008446:Maxillofacial Injuries / Q000000981:diagnostic imaging / Q000523:psychology / Q000601:surgery*; D011859:Radiography; D016728:Self-Injurious Behavior / Q000601:surgery / Q000628:therapy*; D055815:Young Adult