Gunshot Wounds to the Mandible: A 21-Year Urban Trauma Center’s Experience

Abstract

1. Abstract <span style=font-size:10.0pt; font-family: times= new= roman,serif=> <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.1. Purpose: Gunshot wounds to the mandible are complex injuries that are difficult to treat and have a high complication rate [1] . This study examined an urban trauma center’s experience in the methods of treatments used and the outcomes of mandibular gunshot wounds. <span style=font-size:10.0pt; font-family: times= new= roman,serif=> <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.2. Methods: A retrospective review of the trauma center registry identified 105 patients with gunshot wounds to the mandible treated between February 1991 and December 2012. Sufficient data was found on 67 patients and descriptive information was collected regarding demographic information, fracture location, and treatment regimen. Outcome data was measured in patients with documented follow-up of 4 weeks or longer. <span style=font-size:10.0pt; font-family: times= new= roman,serif=> <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.3. Results: A total of 67 patients with mandible fractures due to gunshot wounds were identified. The mean patient age was 30.8 years (range, 15 - 71 years), with most patients being male (86.6%). The mandibular angle was the most commonly affected region (43.4%) followed by the mandibular body (36.3%). 40.3% of patients presented with multiple mandibular fractures. Of the 60 patients who underwent surgical management, 22 (36.6%) underwent closed reduction with Maxilla-Mandibular Fixation (MMF), 3 (5%) underwent external fixation only, 2 (3.3%) underwent MMF and external fixation, 12 (20%) underwent Open Reduction and Internal Fixation (ORIF), and 21 (35%) underwent ORIF with MMF or external fixation. Fifty patients had adequate follow-up time ranging from 4 to 530 weeks (median 18 weeks.) From this group, we identified 19 major and 1 minor complication (42%). Minor complications included complications managed in an outpatient setting (infection treated with oral antibiotics, seroma, etc.). Major complications included infected hardware, infection requiring incision and drainage, non-union, malocclusion, and extrusion of hardware. <span style=font-size:10.0pt; font-family: times= new= roman,serif=> <span style=font-size:10.0pt;font-family: times= new= roman,serif;mso-fareast-font-family:times= roman=>1.4. Conclusions: Mandibular fractures as a result of gunshot wound injury are devastating injuries often characterized by multiple fractures, comminuted fractures, and large areas of missing bone [1,2]. The common presentation of multiple facial fractures and significant anatomic displacement are frequent indications to treat with ORIF [3] . The results of our study show that the complication rate in patients treated with ORIF remains high. The patients included in this study had variable clinical presentations, and we can only conclude that treatments other than ORIF, such as closed reduction with MMF or external pin fixation, must still be considered [1,3-5]. <span style=font-size:10.0pt; font-family: times= new= roman,serif=> 2. Keywords: Fracture; Gunshot wound; Mandible; Maxilla-Mandibular Fixation; Rigid fixation