Lacerations that require subspecialty consultation include those with injury to deep structures such as nerves or ducts, are associated with tissue loss, or that involve the cartilage of the ear or nose Clinical Considerations Most facial lacerations can be repaired by the pediatric emergency medicine physician Injuries that require subspecialist consultation include (i) lacerations with evidence of injury to deep structures (a major motor nerve or a glandular duct), (ii) cases in which a substantial amount of devitalized tissue exists or actual tissue loss has occurred, (iii) wounds in which the amount of bleeding cannot be easily controlled, (iv) full-thickness defects of the ear and nose that involve cartilage, and (v) cases in which it is unclear exactly which tissue to approximate to restore preinjury anatomy and aesthetics (e.g., lips, eyelids, nostrils, ears) Suggested Readings and Key References Goals of Emergency Therapy Druelinger L, Guenther M, Marchand EG, et al Radiographic evaluation of the facial complex Emerg Med Clin North Am 2000;18:393–410 Eggensperger Wymann NM, Holzle A, Zachariou Z, et al Pediatric craniofacial trauma J Oral Maxillofac Surg 2008;66:58–64 Imahara SD, Hopper RA, Wang J, et al Patterns and outcomes of pediatric facial fractures in the United States: a survey of the National Trauma Data Bank J Am Coll Surg 2008;207:710–716 Ryan ML, Thorson CM, Otero CA, et al Pediatric facial trauma: a review of guidelines for assessment, evaluation, and management in the emergency department J Craniofac Surg 2011;22:1183–1189 Vyas RM, Dickinson BP, Wasson KL, et al Pediatric facial fractures: current national incidence, distribution, and health care resource use J Craniofac Surg 2008;19:339–349 Facial Fractures Dogan S, Kalafat UM, Yüksel B, et al Use of radiography and ultrasonography for nasal fracture identification in children under 18 years of age presenting to the ED Am J Emerg Med 2017;35:465–468 Foulds JS, Laverick S, MacEwen CJ “White-eyed” blowout fracture: a case series of five children Arch Dis Child 2013;98:445–446