Abstract
Background
Gunshot injuries to the face in civilian practice are rarely reported. Potential complications in the Emergency Department can have catastrophic consequences, and inappropriate operative management of the facial soft and skeletal tissues are related to outcome.
Methods
A structured diagnostic and management approach is used in our Trauma Unit to deal with gunshot wounds to the face. A retrospective study of 55 patients who sustained gunshot injury to the face was conducted over a 6½-year period. Demographic details, mechanism of injury, and mode of presentation and management were recorded. Mortality and morbidity data were collated.
Results
There were 51 male and 4 female patients. All injuries were caused by low-velocity gunshots, except for one that was a shotgun injury. Overall, 28 of the 55 patients (50%) underwent orotracheal intubation on scene or in the resuscitation room, and 2 had cricothyroidotomy. In addition to the maxillofacial trauma, associated injuries were common. Forty patients underwent operation for maxillofacial trauma, 34 on the day of admission and the remaining 6 within 5 days of injury. Multiple operations over a 2-week period were necessary for 18 of the 40 patients. Complications directly related to the gunshot injury to the face were very limited. Mortality was related to associated injuries.
Conclusions
Gunshot injury to the face in civilian violence is a “benign” condition as long as the Patient’s airway is kept patent and hemorrhage is controlled. Early operative intervention for repair of the soft and skeletal facial structures leads to satisfactory results. Mortality directly related to the facial trauma is uncommon.
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References
Cohen MA, Shakenovsky BN, Smith I (1986) Low velocity hand-gun injuries of the maxillofacial region. J Maxillofac Surg 14:26–33
Demetriades D, Chahwan S, Gomez H, et al. (1998) Initial evaluation and management of gunshot wounds to the face. J Trauma 45/1:39–41
Dolin J, Scalae T, Mannor L, et al. (1992) The management of gunshot wounds to the face. J Trauma 33/4:508–515
Haug RH (1989) Management of low-calibre, low-velocity gunshot wounds of the maxillo-facial region. J Oral Surg 47:1192–1196
Cohen MA, Shakenovsky BN, Smith I (1986) Low velocity handgun injuries of the maxillo-facial region. J Maxillofac Surg 14:26–33
Walker RV, Frame JW (1984) Civilian maxillo-facial gunshot injuries. Int J Oral Surg 13:263–277
Whitlock RIH, Gorman JM (1978) Some missile injuries due to civil unrest in Northern Ireland. Int J Oral Surg 7:240–245
Stiernberg CM, Jahrsdoerfer RA, Gillenwater A, et al. (1992) Gunshot wounds to the head and neck. Arch Otolaryngol Head Neck Surg 118:592–597
Yuksel F, Celikoz B, Ergun O, et al. (2004) Management of maxillofacial problems in self-inflicted rifle wounds. Ann Plast Surg 53:111–117
Osborne TE, Bays RA (1991) Pathophysiology and management of gunshot wounds to the face. In Fonseca RJ, Walker RV, eds., Oral and Maxillofacial Trauma. Philadelphia, WB Saunders Company, pp 672–701
Banks P, Wilson JSP, Sanders R, et al. (1985) Gunshot wounds. In Rowe NL, Williams JL, eds., Maxillo-Facial Injuries, Edinburgh, Churchill Livingstone, pp 561–694
Gant TD, Epstein LI (1979) Low-velocity gunshot wounds to the maxillo-facial complex. J Trauma 19:674–677
Al Shawi A (1995) Open-packing method for the severely comminuted fractured mandible due to missile injury. Br J Oral Maxillofac Surg 33:36–39
Terry BC (1969) Facial injuries in military combat: definitive care. J Oral Surg 27:551–556
Morgan HH, Szmyd L (1968) Maxillo-facial war injuries. J of Oral Surg 26:727–730
Behnia H, Motamedi MHK (1997) Reconstruction and rehabilitation of short-range, high-velocity gunshot injury to the lower face. J Craniomaxillofac Surg 25:220
McLean JN, Moore CE, Yellin SA (2005) Gunshot wounds to the face—acute management. Facial Plast Surg 21(3):191–198
Motamedi MHK, Behnia H (1999) Experience with regional flaps in the comprehensive treatment of maxillo-facial soft-tissue injuries in warfare victims. J Craniomaxillofac Surg 27:256
Motamedi MHK, Hashemi HM, Shams MG, et al. (1999) Rehabilitation of war-injured patients with implants: analysis of 442 implants placed during a 6-year period. J Oral Maxillofac Surg 57:907
Motamedi MHK, Behnia H (1999) Experience with regioinal flaps in the comprehensive treatment of maxillo-facial soft-tissue injuries in warfare victims. J Craniomaxillofac Surg 27:256
Dobson JE, Newell MJ, Shepherd JP (1989) Trends in maxillofacial injuries in wartime (1914–1986). Br J Oral and Maxillofac Surg 27:441–450
Berlin R, Gerlin LE, Jenson B, et al. (1977) Local effects of assault rifle bullets in live tissues. Acta Chir Scand Suppl 477:5–48
Osborne TE, Bays RA (1991) Pathophysiology and management of gunshot wounds to the face. In Fonseca RJ, Walker RV, eds, Oral and Maxillo-Facial Trauma, vol. 2, Philadelphia, WB Saunders Company, 672–679
Williams CN, Cohen M, Schultz RC (1988) Immediate and long-term management of gunshot wounds to the lower face. Plast Reconstr Surg 82/3:433–439
Motamedi HKM (2003) Primary management of maxillofacial hard and soft tissue gunshot and shrapnel injuries. J Oral Maxillofac Surg 61:1390–1398
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This work was supported by the German Ministry of Defence.
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Glapa, M., Kourie, J.F., Doll, D. et al. Early Management of Gunshot Injuries to the Face in Civilian Practice. World J Surg 31, 2104–2110 (2007). https://doi.org/10.1007/s00268-007-9220-2
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DOI: https://doi.org/10.1007/s00268-007-9220-2