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Is Dimple Formation In The Cheek Following Facial Trauma Normal In An Infant?

Posted on Thu, 23 Jun 2016

Question: Hello. My daughter had a blunt impact against a coffee table at around 12 months, she had a bruise for over a week. We took her to the doctor, however we never have heard a satisfying answer on why she still has an asymmetrical smile. The injured cheek seems less chubby and her smile line veers off towards her ear and stops rather than a downward line to her lip. She's had this scar for over a year and I'm thinking its permanent. What may have caused this? Is there any solution? Thanks.

Answered by Dr. Naveen Kumar Nanjasetty (4 hours later)

Brief Answer:
Where was the exact site of injury...

Detailed Answer:
Hi

Thanks for posting the query

Could you please clarify the following:
1. Where was the injury?
2. Was any CT scan done during the initial days?
3. Were there any other constitutional symptoms associated?
4. Could you please post images of the site of the lesion and if possible, the image while smiling. This is to assess the probable nerve damaged and the muscles affected.

Awaiting for your reply...

Regards
Dr. Naveen Kumar N
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Naveen Kumar

Follow up: Dr. Naveen Kumar Nanjasetty (22 hours later)

Hello.
The initial Dr thought the future potential issues from the radiation of a CT scan would outweigh the benefits of seeing the cause of the difference in my daughters smile. I definitely don't want to add any issues to her life. However, I'm very curious at the cause and whether there will be any solution if she wants it as she grows up. Her injury was a large linear bruise following almost her natural smile line but instead of finishing near the lip it veered off toward her ear and impacting the roundness of her cheek. Now, a year plus after the bruise, her cheek has a dent where the bruise was. I'd send a pic but I'm uncertain how to send it to you. Thanks.

I think I got a pic linked up to the site. The dent gets deeper the more intense the smile, but I hope this gives you an idea of what I'm talking about

Please check the attached reports for the pictures I uploaded. Im looking forward to your response.

Answered by Dr. Naveen Kumar Nanjasetty (27 hours later)

Brief Answer:
Dimple is secondary to the fibrosis formed post trauma...

Detailed Answer:
Hi

Thanks for writing back and posting the images. It has indeed made my work easier.

Initially, with your description, I was suspecting a facial nerve injury with damage to the marginal mandibular nerve. Now, after seeing the images, I had to change my diagnosis.

Young children are less likely to break a facial bone because they have fat pads that cushion their faces and their bones are more flexible. Formation of a dimple in the cheek following facial trauma is not uncommon. This is due to the fibrosis formed in the soft tissue layer post trauma. Causing in-drawing of the former and the adjoining skin. Hence, due of loss of fat and formation of fibrosis, a dimple is noticed. Most of the dimples usually resolve within a span of one year.

Those lesions which are persisting for more than a year may require surgical intervention. Cosmetic surgery involving filling of the dimple is the treatment of choice. This is usually performed by plastic surgeons who will inject fat into the dimple. The procedure is considered to be safe without any major complications and scar.

Hope this answers your query: I will be available for the follow-up queries.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Naveen Kumar

Follow up: Dr. Naveen Kumar Nanjasetty (6 hours later)

Thank you for your response. That makes me feel much better! Is there any benefit of adding fat to the dimple while she's young or can we wait and see if it subsides as time goes by? Thanks again for your help...

Answered by Dr. Naveen Kumar Nanjasetty (26 hours later)

Brief Answer:
Normally, the cosmetic surgeons prefer to do it when the child is 10 years

Detailed Answer:
Hi

Welcome back

I since apologize for the delay in replying back.

Normally, the cosmetic surgeons prefer to wait till the child becomes 10 years old. But, a few experienced surgeons do this procedure even at an younger age, as it doesn't involve much morbidity. Hence, you can discuss this with an apt cosmetic surgeon near to your place and decide about it.

Hope this clarifies your doubts. I wish the child a very good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Naveen Kumar Nanjasetty (9 hours later)

Thanks again. Your help is much appreciated.

Answered by Dr. Naveen Kumar Nanjasetty (6 hours later)

Brief Answer:
I wish her good health...

Detailed Answer:
Hi

Thanks for writing back

I pray god to bestow his bountiful blessings on your daughter. I wish her good health.

Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon

Note: Consult an experienced Otolaryngologist / ENT Specialist online for further follow up on ear, nose, and throat issues - Book a Call now.

Above answer was peer-reviewed by : Dr. Arnab Banerjee