Maxillofacial Gunshot Wounds

Abstract

The majority of maxillofacial gunshot wounds are caused by suicide attempts. Young men are affected most often. When the lower one-third of the face is involved, airway patency (1.6% of the cases) and hemorrhage control (1.9% of the cases) are the two most urgent complications to monitor and prevent. Spinal fractures are observed with 10% of maxillary injuries and in 20% of orbital injuries. Actions to treat the facial gunshot victim need to be performed, keeping in mind spine immobilization until radiographic imaging is complete and any required spinal stabilization accomplished. Patients should be transported to a trauma center equipped to deal with maxillofacial and neurosurgery because 40% require emergency surgery. The mortality rate of maxillofacial injuries shortly after arrival at a hospital varies from 2.8% to 11.0%. Complications such as hemiparesis or cranial nerve paralysis occur in 20% of survivors. This case has been reported on a victim of four gunshot injuries. One of the gunshots was to the left mandibular ramus and became lodged in the C4 vertebral bone.

Unusual route of a bullet: From scapula to eye

“…Moreover, especially the injuries to the neck and maxillofacial region could end with high morbidity and mortality. [123456791012] GSI to the orbit, especially the ones penetrating the globe could have devastating effects on all intra- and peri-orbital structures. [234516] As the bullet has both forward and rotatory movements, it possesses much higher amounts of kinetic energy to cause more damage in the eye.…”

“…[3456] Moreover, it was also reported that spinal fractures could be observed with 10% of maxillary injuries and in 20% of orbital injuries. [7] The complication rate is higher in orbitocranial injuries, twice the rate as that of penetrating cranial injury not affecting the orbit. [6] Overall, the mortality rate of maxillofacial gunshot wounds was reported up to 11.0% in some series and multiple wounds were reported in 36% of these cases.…”

“…[6] Overall, the mortality rate of maxillofacial gunshot wounds was reported up to 11.0% in some series and multiple wounds were reported in 36% of these cases. [57]…”

Surgical Management of a Firearm Injury in the Infraorbital Area

“…The typical management of these injuries requires primary focus on clearing and controlling the airway (patency), normally with a tracheostomy, followed by hemorrhage control (2,3,11,12). Most of these procedures are then followed by hemodynamic resuscitation, evaluation of other affected areas and reconstructive surgery if needed (11,12).…”

“…The typical management of these injuries requires primary focus on clearing and controlling the airway (patency), normally with a tracheostomy, followed by hemorrhage control (2,3,11,12). Most of these procedures are then followed by hemodynamic resuscitation, evaluation of other affected areas and reconstructive surgery if needed (11,12). Residual problems can appear in an individual manner, or mixed depending on the area and magnitude of the impact, and can include: nerve palsy, blindness, hemiparesis, mental/ psychiatric disorders, and epiphora (11,12).…”