What is the recommended treatment for a facial hematoma?

Facial Hematoma Treatment

For facial hematomas, apply localized cold therapy (ice packs or cold compresses) as soon as possible to reduce hematoma size and promote hemostasis, combined with rest and elevation of the affected area. 1

Immediate Management

Cold Therapy Application

• Begin active cooling immediately using cool or non-freezing water, ice packs, or gel pads 1
• Ice packs and saltwater packs provide superior cooling compared to traditional metal enswells or other materials for facial tissue 2
• Apply cold therapy for short intervals to avoid tissue damage, though optimal duration is not definitively established 1
• Very low-quality evidence from post-procedural studies suggests cold compression can reduce hematoma size by approximately 20 cm² compared to compression alone 1

Supportive Measures

• Elevate the affected area and ensure rest to minimize continued bleeding 1
• Monitor for signs of expansion, including increasing swelling, discoloration, or changes in contour 1
• Avoid needle aspiration of facial hematomas due to risk of introducing infection 3

Clinical Assessment

Determine Severity

• Small, stable hematomas: Manage conservatively with cold therapy, observation, and reassurance 1
• Large or expanding hematomas: Consider imaging (ultrasound preferred) to assess size and rule out vascular injury 1
• Hematomas compromising function: Evaluate for airway compromise, vision impairment, or neurovascular compression requiring urgent intervention 1

Warning Signs Requiring Escalation

• Progressive enlargement despite conservative measures 1
• Evidence of compartment syndrome or tissue compromise 1
• Signs of infection (increasing pain, erythema, warmth, purulent drainage) 4
• Underlying structural injury requiring surgical repair 5

Advanced Treatment Options

For Persistent or Organized Hematomas

• Hyaluronidase injection (1,500 IU mixed with 2 mL normal saline) administered subcutaneously in a crisscross pattern has shown benefit for treating post-traumatic hematomas and preventing fibrosis progression 6
• This intervention is particularly useful when fibrosis develops at the contusion site during follow-up 6

Surgical Evacuation Indications

• Hematomas compromising vascular structures or causing luminal stenosis 1
• Large hematomas with mass effect or functional impairment 1
• Infected or organized hematomas not responding to conservative management 1

Prevention of Complications

Infection Prevention

• Do not routinely use prophylactic antibiotics unless there is an open wound or high infection risk 4
• Monitor for clinical signs of infection during healing 4
• If wound care is needed, irrigate with sterile saline and apply non-adherent dressings 4

Fibrosis Prevention

• Early treatment with cold therapy and appropriate compression may reduce fibrosis risk 1, 6
• Consider hyaluronidase injection if fibrosis begins developing during follow-up 6

Common Pitfalls to Avoid

• Do not apply excessive pressure that could compromise blood flow or cause tissue ischemia 1
• Avoid aspiration of facial hematomas in non-surgical settings due to infection risk 3
• Do not delay evaluation of expanding hematomas, as early intervention prevents complications 1
• Do not use metal enswells as primary cold therapy—ice packs are significantly more effective 2

Follow-Up Protocol

• Reassess within 24-48 hours for small hematomas to ensure resolution 1
• Monitor for delayed complications including fibrosis, contour irregularities, or persistent swelling 6
• Consider specialist referral for large hematomas, those involving critical structures (periorbital, auricular), or those not responding to conservative management 5