What Should I Do About a Visible Dent Running along My Daughters Cheek After Falling Into a Door Frame? (Photos)

Question

Hello, My daughter fell into a door frame at school. Once the swelling went down there is a visible dent running the lenghth of her cheek. Its worse when she really smiles, and worst when she is crying. She is a little over 2 years old. Is there something I can do to help the skin heal? Thank you for your responses... and your willingness to take these questions.

	Additional Information Added 9/22/2011

	The injury happened on August 19th at her daycare, so the swelling has already gone down. She was evalauted by her doctor, and there was no tenderness on the bone. We did not do an xray or CT scan. It does not bother her when I touch it to massage. The pictures are of her crying because that is when it is the most visible. She is usually very smiley... but you can always see it.

Aaron Stone, MD · Answer

The injury is quite obvious and your concern is understandable. The question is is this a soft tissue or bone injury or both. I have seen similar problems in patients whose lap belt slipped down onto their upper thighs during a car accident leaving them with an indent of the thigh. The cause was death/rupture of fat cells in the area of the indent. Just looking at these photos I am not sure of the utility of doing radiologic studies like CT or MRI. The child needs a thorough face to face physical examination to see if such tests are warranted. If you decide to treat the indent you have to be very careful because what may look good now could look horrendous in adulthood. The facial muscles seem to work well therefor in the absence of bone injury it would be most prudent to wait until it bothers her as by then the problem may be smaller and on a face that is not growing so rapidly.

	I hope you realize that this format of posting questions and receiving answers lacks the face to face direct communication required for you to make an informed decision regarding your surgery.

	My response to your question/post does not represent formal medical advice or constitute a doctor patient relationship. You need to consult with i.e. personally see a board certified plastic surgeon in order to receive a formal evaluation and develop a doctor patient relationship.

Kenneth D. Steinsapir, MD · Answer

It is painful to look at these pictures.  You did not really spell out a time frame here.  I think she should be assessed by her pediatrician and referred to a facial plastic surgeon if appropriate.  I do not think she should be rushed off for a CT scan without the examination by her pediatrician.  She can be examined for point tenderness and bone step offs.  If these are not present, irradiating her face and brain with the CT scan may or may not be reasonable. If there is no point tenderness and no step offs in the bone, and no other indication to perform a CT scan, then there is really nothing surgical to do at this moment.  I think in that case watchful waiting will be appropriate.  If she needs and examination by a specialist her pediatrician can make that referral.  I hope she feels better soon.

David A. Bray, Sr., MD · Answer

What tradgedy. You need good x-ray and perhaps an mri. If ther is no boney issue patience and gentle massage may help. You will need to see a good plastic surgeon for follow up

Peter A. Aldea, MD · Answer

A blow which leaves such a soft tissue indentation should be evaluated with a CT scan to make sure it did not cause any fractures of the skull or cause other internal injuries. Once this is ruled out, I would gently massage the "hills" to the valley to reduce swelling and potentially move any displaced fat back into the depression. In some cases, prolonged pressure may result in pressure death of the underlying fat resulting in a "Saber Slash" deformity and may require filling with fat or other fillers.

	For the time being, I would rule out serious underlying injuries and then cajole / bribe / distract her while gently massaging the area several times a day.

	Good Luck.

What Should I Do About a Visible Dent Running along My Daughters Cheek After Falling Into a Door Frame? (Photos)

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What Should I Do About a Visible Dent Running along My Daughters Cheek After Falling Into a Door Frame? (Photos)

Answers (4)

Answer: What Should I Do About a Visible Dent Running along My Daughters Cheek After Falling Into a Door Frame?

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