Published online Aug 20, 2013. doi: 10.5321/wjs.v2.i3.62
Revised: March 24, 2013
Accepted: April 18, 2013
Published online: August 20, 2013
Processing time: 101 Days and 17 Hours
AIM: To assess our management of patients suffering from missile injuries to the maxillofacial region.
METHODS: From December 2009 to September 2012, 40 patients with missile injuries (high velocity gunshot and bullet wounds, explosive injuries and shrapnel etc.) affecting the maxillofacial region were treated. All except for 2 patients were males. All had soft tissue injuries with or without bone injuries. These patients were referred to the plastic and maxillofacial surgery ward of our hospital. The patients were 19 to 65 years of age (mean 45 years). In 19 cases, there were missile injuries to other parts of the body, especially the lower extremities. All of the patients were managed by early soft tissue debridement, comprehensive reconstruction and antibiotics. This retrospective study was approved by the IRB and ethical committees.
RESULTS: The majority of injuries were caused by high velocity projectiles (88%) and the remaining by car explosions or dynamite blasts (12%). 40 patients were treated surgically. Thirty patients had soft tissue loss (75%) and 20 patients (50%) had bone loss; there was combined soft tissue and bone loss in 10 (25%) patients. Facial fractures were in the orbital bones in 10 cases, maxillary in 7, nasal in 5 and the mandible in 3 cases. We used primary repair in the majority of soft tissue defects (25 of 40 cases). Bone repair was done primarily at the same stage using miniplates, titanium screws or wires. In some cases with a bone defect, iliac bone grafts were used simultaneously or in the later stages (mandibular defects). There was no failure of bone reconstruction in our cases. Infections occurred in two cases and were treated with systemic antibiotics and dressing changes, without any long term sequelae.
CONCLUSION: Our principles for soft tissue reconstructions were according to the reconstructive ladder and included primary repair, local flaps, skin grafts and regional flaps depending on the extent of damage. Primary repair in facial missile defects was not associated with increased morbidity or complications in this series. We recommend this approach when feasible.
Core tip: Exposure to missile injuries may result in unique and complex injury patterns from projectiles or fragments. Injuries to the face due to firearms are either high velocity or low energy; high velocity projectiles can result in devastating functional and aesthetic consequences, shattering the hard tissues. Early intervention in facial firearm injuries resulted in restoration of occlusion and continuity of the jaw, fixation of luxated or extruded teeth, early return of function, prevention of segment displacement and tissue contracture, less scarring and decreased need for major bone graft reconstruction later on.