High-energy blunt or penetrating impact leads to great variability in facial injury patterns. Although the mechanism, pattern, and distribution of forces vary, the resultant damage to hard and soft tissues requires dedicated planning and execution of debridement and reconstructive procedures. This article evaluates the initial management of patients sustaining high-energy facial impact injuries resulting in one or more comminuted or displaced facial fractures, with accompanying severe facial lacerations and/or soft tissue defects and avulsion injuries. Seventy-three patients met the criteria for high-energy traumatic injuries at Jackson Memorial/University of Miami Medical Center between 2003 and 2013 and are included in this article. Thirty-nine patients sustained one or more gunshot wounds to the face, and 34 patients were involved in high-speed motor vehicle collisions; all patients met our criteria for high-energy trauma. The treatment protocol for these injuries involves meticulous surgical exploration and assessment, aggressive debridement, early definitive reduction/fixation, and reconstruction as necessary.
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