Open Wound of the Cheek

First aid for a cheek wound

1. Stop the bleeding. Press firmly with a clean cloth or gauze for 10 minutes without lifting to check. Facial wounds bleed heavily but usually stop with pressure.
2. Clean it. Rinse under cool running tap water for several minutes to wash out dirt. Use mild soap around (not deep in) the wound. Avoid hydrogen peroxide, alcohol or iodine in the wound, which damage tissue.
3. Check the size and depth. If the edges gape, the cut is deep, or it goes through to the mouth, it needs closing by a clinician. Cover it with a clean, damp dressing and go.
4. Cover small wounds. Apply petroleum jelly and a nonstick bandage. Keep it moist and covered.
5. Ice. Wrap ice in a cloth and apply for 10 to 15 minutes at a time to reduce swelling.
6. Pain relief. Acetaminophen (paracetamol) or ibuprofen; follow the label dose.

Why cheek wounds are different

Facial nerve injury

The branches of the facial nerve fan out across the cheek from in front of the ear. A deep cut, especially behind a line dropped down from the outer corner of the eye, can sever a branch. Signs include inability to raise the eyebrow, close the eye tightly or smile evenly on that side. A cut nerve should be repaired by a surgeon, ideally within about 72 hours while the cut ends can still be stimulated and found. See nerve injury.

Parotid duct injury

The parotid duct (Stensen's duct) runs across the middle of the cheek, roughly along a line from the earlobe to the middle of the upper lip, and opens inside the mouth opposite the upper molars. A deep cut along this line can divide it. Clear fluid leaking from the wound, especially when eating, or a swelling that refills (a sialocele) suggests a duct injury. These are repaired surgically. See parotid gland injury.

Through-and-through wounds

A cut that passes completely through the cheek into the mouth is closed in layers: the inside lining, the muscle and the skin. Antibiotics are often given because mouth bacteria contaminate the wound.

Facial fractures

A hard blow that causes a cheek wound can also break the cheekbone (zygoma) or upper jaw. Numbness of the cheek and upper lip, double vision, a change in how your teeth meet, or a flattened cheek are clues. See fracture of the facial bones.

Types of facial wounds

How a cheek wound is repaired

A clinician will numb the area, wash it out thoroughly, remove debris, and check for nerve, duct and bone injury. Facial wounds are usually closed within 24 hours and sometimes later, because the good blood supply lowers infection risk. Options include:

• Skin adhesive (tissue glue): for small, straight, low-tension cuts.
• Adhesive strips: for small, superficial cuts.
• Fine stitches: for most lacerations. Deeper absorbable stitches may be used under the skin. Facial skin stitches are removed after 4 to 6 days to avoid stitch marks.
• Plastic surgery or ear, nose and throat (ENT) repair: for complex wounds, nerve or duct injury, tissue loss, or wounds in children who cannot keep still.

Bites to the face are usually closed, unlike many bites elsewhere, after careful washing, and antibiotics such as amoxicillin-clavulanate are commonly prescribed. A facial laceration page covers cuts across the rest of the face.

Your tetanus status will be checked. A booster is advised if your last dose was more than 5 years ago for a dirty wound, or more than 10 years ago for a clean one. For animal bites, rabies risk is assessed.

Facial wound healing and scar care

Facial skin heals faster than skin elsewhere. Typical stages:

• Days 1 to 3: swelling and bruising peak, then start to fade.
• Days 4 to 6: stitches are removed. The wound has closed but is still weak.
• Weeks 2 to 6: the scar is pink and may feel firm.
• Months 6 to 12: the scar flattens and fades as it matures.

To help it heal well:

• Keep the wound moist with petroleum jelly and covered for the first week. Moist wounds heal faster and scar less than wounds left to scab.
• Do not pick scabs.
• Protect the scar from the sun for at least 6 to 12 months with SPF 30+ sunscreen or a hat. Sun exposure darkens new scars permanently.
• Once the skin is closed, gentle massage and silicone gel or sheets can flatten a raised scar.
• See a doctor if the scar becomes thick, raised, itchy or spreads beyond the wound edges. See scar.

Signs of infection

Watch for increasing pain after day 2, spreading redness, warmth, swelling, pus, a bad smell, red streaks or fever. A wound infection on the face needs prompt antibiotics, because facial veins connect to veins around the eye and brain.

Frequently asked questions

Does a cut on my cheek need stitches?

A cheek cut usually needs closing if it gapes open, is longer than about 1 to 2 cm, is deep enough to see fat, keeps bleeding after 10 minutes of pressure, or goes through to the mouth. Glue or strips may be enough for small cuts. Get it closed within 24 hours for the best result.

How long does a facial wound take to heal?

The skin closes within about a week, and facial stitches come out after 4 to 6 days. The wound is weak for several more weeks. The scar keeps remodeling for 6 to 12 months, gradually fading from pink to pale and becoming flatter and softer.

How can I reduce scarring from a cheek wound?

Keep the wound clean, moist and covered for the first week, do not pick scabs, and protect it from sunlight for at least 6 months. After the skin has closed, silicone gel or sheets and gentle massage help. A well-aligned repair by a skilled clinician makes the biggest difference.

What happens if the facial nerve is cut?

Part of the face becomes weak on that side, for example the eyebrow, eyelid or smile. A cut nerve branch in the cheek should be repaired by a surgeon, ideally within about 3 days. Very small branches near the mouth and nose often recover without repair.

Is a dog bite on the cheek dangerous?

Dog bites to the face need same-day care. They carry a high infection risk and often tear tissue. The wound is washed out, usually closed, and antibiotics are commonly prescribed. Tetanus and rabies risks are assessed. Children are especially prone to face bites.