Gunshot Wounds to the Face-Acute Management

Abstract

The complex facial trauma victim poses a genuine therapeutic challenge as a whole, and may be particularly challenging to the medical team. The literature on acute management of gunshot wounds to the face is scarce. We performed an extensive review of the English-language literature in an effort to better delineate the diagnosis and acute management of these injuries. Most of these injuries do not present with initial threat to life and can safely be managed non-operatively. Definitive treatment is often deferred in patients with multiple, or more severe, injuries. Airway compromise is the most frequent and most life-threatening early problem reported in most series. CT scan remains the most useful method in the evaluation of these types of injuries and associated cervical spine lesions. Facial bleeding is best controlled by angiography and subsequent embolization. Anatomic repair of soft tissue and bony injuries is recommended to obtain an optimal functional and aesthetic outcome. Despite the creation of some algorithms, no clear correlation has been found between the site of entrance wound and the injuries and outcome of gunshot wounds to the face.

Maxillofacial Gunshot Injuries at an Urban Level I Trauma Center—10-Year Analysis

“…Of these, 136 (6.9%) were GSW to the face, a percentage consistent with previous reports (6 -8%) 7,8,12 (Figure 1). 90 of these 136 patients with facial GSW were evaluated by the OMS department (66%), and 55 patients met inclusion criteria and were ultimately selected for the study.…”

“…Relative to surgical treatment, whenever possible, early definitive intervention was favored 4,6,7,8,10,11,14 . Attempts to address the repair of fractures in less than 72 hours from admission were always made excepting cases with significant concomitant injuries, such as brain injury or respiratory failure.…”

“…Central nervous system injury was most commonly associated with mid-and upper face gunshots. The incidence of CNS trauma reported in literature is 17 -22%, and to the cervical spine it is 8% 7,9,15 . Our study…”

“…Penetrating facial trauma is more likely to be treated at a local Level -1 trauma center, especially in an urban setting. Facial gunshot wounds (GSW) are complex due to involvement of the craniofacial skeleton, airway compromise, intracranial and vascular systems, and psychological issues [4][5][6][7][8][9][10][11] . Optimal management of facial gunshot wounds remains controversial in terms of timing of treatment and reconstructive techniques.…”

Maxillofacial Reconstruction of Ballistic Injuries

“…In the maxillofacial region many ballistic injuries may be treated early; and several authors have opposed the strategy of universally delaying all surgical interventions of facial ballistic injuries suggesting a more comprehensive surgical operation can be done primarily in many [2,[6][7][8]. Good results following acute treatment of projectile facial wounds during a 4-year period in the Afghan war has been reported more recently.…”