Management of Maxillofacial Problems in Self-Inflicted Rifle Wounds

Abstract

Severe gunshot wounds to the face, produced by high-velocity rifles or shotgun blasts, present a formidable challenge to reconstructive surgeons. In this study, the results of 14 cases with gunshot wounded faces caused by fire from rifles are presented, and the principles of the management of those victims were determined. These patients had attempted to commit suicide and placed the muzzles of the rifles beneath their chins. The ages of the patients ranged from 20 to 24 years, with a mean age of 22 years. These wounds were caused by close-range gunshots (<10 cm), and the missiles had high velocity (more than 800 m/second). All patients had wounds in their submental triangle areas. The exit sites of the missiles differed among patients. All exit wounds were in the angle limited by the deviation from the gun-barrel axis. After clinical and radiologic evaluation and conservative debridement of all devitalized tissues, the fractures were reduced and stabilized appropriately. Large bony defects were treated by bone grafting, and all soft tissue lesions were closed in layers. The entrance and exit sites were covered primarily after thorough debridement except one case whose defect was reconstructed with bilateral sternocleidomastoid (SCM) flaps, one for submental skin and the other for the mouth floor. Intraoral soft tissues were then repaired by primary closure, tongue flaps, or SCM flaps in case they were necessary. Free tissue transfers were not required for treatment of secondary soft-tissue problems. Resolution of tissue edema, softening of scars in time, and insertion of bone graft may improve the deformity significantly. The initial anatomic reconstruction of the existing bone skeleton and the maximal use of regional tissue for cutaneous reconstruction provide an esthetic appearance that can never be duplicated by secondary reconstruction.

Late Oropharyngeal Functional Outcomes of Suicidal Maxillofacial Gunshot Wounds

“…9,12,13 The results of reconstructive procedures of 14 cases with gunshot-wounded faces caused by rifle fire were presented by Yuksel et al 13 More recently, Firat and Geyik 9 evaluated the reconstruction methods in 12 patients with gunshot wound-related mandibular and maxillofacial bony and soft tissue defects. Despite the severity of the injuries, all authors achieved acceptable cosmetic results.…”

Inpatients With Gunshot Wounds to the Face

“…Several reports document acceptable functional and aesthetic outcomes after local and/or regional flap advancement (eg, sternocleidomastoid muscle or cheek advancement flaps). 7,20,21 In cases of minimal soft tissue or bony damage, conservative wound debridement with tension-free primary closure has been performed successfully. 2,21 The decision to use microvascular FTT in this series was based on the severity of injuries encountered, including massive soft tissue avulsion and loss of mandibular bone.…”

“…7,20,21 In cases of minimal soft tissue or bony damage, conservative wound debridement with tension-free primary closure has been performed successfully. 2,21 The decision to use microvascular FTT in this series was based on the severity of injuries encountered, including massive soft tissue avulsion and loss of mandibular bone. Because of the relatively low number of case series in the medical literature on the long-term surgical management of maxillofacial GSWs and the lack of head-to-head comparisons between the use of microvascular FTT or local and regional tissue rearrangement techniques, selection of the most appropriate surgical procedure will likely remain debatable, dependent on a host of factors ranging from extent of injury to overall patient health.…”

Survivors of Self-inflicted Gunshot Wounds to the Head

“…16 The intricate nature of the face, likelihood of injury to the central nervous system, and psychiatric considerations all increase the challenges of reconstruction and rehabilitation. 15,17 This study aims to assist ophthalmologists in the treatment of such patients as well as examine the costs and socioeconomic factors associated with these injuries.…”