Soft tissue injuries of the head and neck are usually caused by blunt or penetrating trauma and require careful clinical assessment. Imaging may be required to rule out fractures and other complications. Initial management of all head and neck injuries follows the Advanced Trauma Life Support (ATLS) protocol and includes addressing life-threatening conditions, such as airway compromise and bleeding. Once initial management has been concluded and complications have been ruled out, open head and neck wounds are managed similarly to other acute open wounds.
Follow the head injury.in any patient with suspected severe
Significant trauma 
- Ensure dislocations are excluded. until or
- Anticipate the need for . 
- Assess for and begin .
- Evaluate for and perform or as clinically indicated.
- Assess for ear injuries. and
Open wounds 
- Begin (e.g., apply pressure dressing to scalp wounds, ).
- Assess for embedded foreign bodies and associated injuries.
- Consult a specialist prior to wound closure for:
- Provide .
- Consider additional as clinically indicated.
- Provide and consider ice packs to treat swelling.
- Manage associated injuries (e.g., replantation of , reduction of ).
For basic principles of wound care, see “lacerations,” and “Neck wounds” for specific considerations..” See sections on “Facial wounds,” “Scalp
Hemorrhage control and wound cleaning 
- Apply to control any active bleeding.
- Irrigate the wound with normal saline.
- Manually remove any residual foreign bodies.
- Limit tissue debridement to obviously nonviable tissue.
Anesthesia and supportive care
- Administer .
- Consider to minimize distortion of wound edges.
- For children: Consider or .
- Administer and as indicated.
Wound closure 
- Abrasions can be treated with a thin layer of antibiotic ointment.
- Consider superficial lacerations. for small
- For nongaping wounds, use a single layer of nonabsorbable sutures.
- For gaping wounds (i.e., deeper than the dermis), perform layered closure.
- Consider contaminated wounds or wounds older than 12 hours.  for grossly
- See also “Closure of acute open wounds.”
- Nonabsorbable facial sutures are typically removed after 3–5 days.
- See also “Follow-up” in “ .”
Eyebrow lacerations 
- Examine sensory functions of the supraorbital and supratrochlear nerves. 
- Perform layered wound closure.
Do not shave eyebrows, as eyebrow hair is an important landmark for correct reapproximation and regrowth is unpredictable. 
Cheek lacerations 
- Consult a specialist in the presence of complications, e.g.:
- and/or injury
- If no complications are present, proceed with wound closure:
Open wounds of the mouth 
- Consult plastic surgery, ENT, oral maxillofacial surgery, and/or dentistry if any of the following are present:
- If missing or chipped teeth: Evaluate wounds for embedded tooth fragments (by inspection, probing, and/or soft-tissue x-ray).
- If no complications, proceed with wound closure.
Lip lacerations 
- Mark the local anesthesia. prior to infiltrating
- Repair involved muscle with multiple layers to optimize cosmetic outcomes.
- Align the vermilion border with a single stitch using a nonabsorbable suture.
- Close the oral mucosa and with absorbable sutures.
Do not use lacerations.  to repair lip
Oral mucosa and tongue lacerations 
- Close deep or gaping tongue lacerations with nonabsorbable sutures.
- For through-and-through oral lacerations:
Other anatomic locations 
- Prioritize hemostatic control for actively bleeding lacerations.
- Consult neurosurgery if there is evidence of galea disruption and/or a skull fracture.
- For uncomplicated lacerations, perform primary wound closure with staples, sutures, or .
- Do not routinely shave the scalp prior to wound repair. 
- Suspected injury to deeper structures : Follow the .
- Simple superficial wounds: Follow the approach to .