Visiting Professor Sclafani Gives Insights on Facial Trauma Trends

Anthony Sclafani, MD, FACS, chief of Facial Plastic Surgery at Weill Cornell Medical College, recently shared his evolving perspectives on facial trauma with the Department of Otolaryngology – Head and Neck Surgery and Houston Methodist. His nuanced observations, patient care, and research confirm a "less aggressive" surgical intervention pattern. “I knew this about my own practice, but my conservative thinking was confirmed in research as well as observation,” said Sclafani who also is professor of Otolaryngology at Weill Cornell and serves as the Quality and Patient Safety Chair in the department. He was appointed as Assistant Dean for Admissions in October 2024. “Proper triage is key – identifying injuries, involving, and coordinating care of all injuries with the correct colleagues in a timely way is critical,” Sclafani said. He highlighted geographic variability in trauma causes, based first on his home ground of New York City where pedestrian traffic causes more falls and results in more facial trauma than seen elsewhere in more vehicle traffic and car crashes. “Just because a patient “only” tripped and fell doesn’t mean they didn’t sustain a severe injury.” Statistics reveal that nearly 20 percent of facial trauma patients present with skull fractures or intracranial bleeding—of which he warns, “A facial fracture can wait, but a bleed in the brain can’t.”

The traditional concept that “significant” forces are required to generate “significant” facial fractures does not always apply. Often, even relatively low force injuries can cause facial fractures, he said in Houston Methodist Grand Rounds followed by a day of lectures, classes and face-to-face meetings with physicians, researchers, residents and faculty from the Texas Medical Center. Many types of facial fractures can be associated with cranial bone fractures as well as intracranial injuries such as cerebral contusions and sub-ararachnoid and subdural hemorrhages, he said. “Patients usually have more than one facial fracture – always look!” he said. The greatest expenses for the treatment of facial fractures are associated with ICU and nursing care, he said. These are generally due to associated cranial, intracranial, and spinal injuries. Surgical fees are a very small part of the cost of caring for facial trauma patients, he added. Sclafani stressed the need for vigilance in evaluating facial trauma patients: “Do not assume primary and secondary assessments were completed or correct,” he said. “Understand the scope of all the patient injuries and beware the “casual” handoff.” He also stressed: “Imaging supplements—does not replace—a thorough exam.” For fracture identification, he advocated a methodical approach by first using the 2D CT images to identify fracture locations and patterns, and only then employing 3D CT reconstructions for finer analysis. Sclafani’s career includes prior appointments at New York Medical College, Mount Sinai School of Medicine and The New York Eye & Ear Infirmary, as now in leadership at Weill Cornell Medical College. He received his undergraduate degree from Columbia University, medical degree from University of Pennsylvania and Master of Business from University of Massachusetts-Amherst. He is an accomplished author—five textbooks and over 150 peer-reviewed articles—and holds lead editorial positions at Facial Plastic Surgery and Facial Plastic Surgery Clinics of North America. Notably, he has received the Ira Tresley Award (twice) and the Sir Harold Delf Gillies Award for original research. His current research interests include aesthetic rhinoplasty and facial cosmetic surgery. “I went into academic medicine, in addition to providing state-of-the-art medical care, to understand why we do what we do and why it works, to explore how we can do this more effectively and to teach and inspire the next generation to continue to provide and improve medical care. because I feel challenged to teach,” he said. This philosophy has guided his mentorship, encouraging future otolaryngologists to engage in research and critical inquiry from their earliest training. Weill Cornell Medical College and Houston Methodist Hospital became affiliated in 2004. In 2021, Weill Cornell Graduate School of Medical Sciences began offering doctorates at Houston Methodist in physiology, biophysics and structural biology and in neuroscience. Then, most recently, Houston Methodist with Weill Cornell faculty began participating in selection of applicants for Weill Cornell Medical College