High-Velocity Ballistic Injuries Inflicted to the Maxillofacial Region.

Abstract

Gun-shot trauma inflicted to the maxillofacial region results in multiple injuries which significantly impacts management and reconstructive options. The authors investigated the efficacy/outcomes of primary management of maxillofacial trauma inflicted in ballistic injuries. This is a retrospective descriptive study carried out solely at 15 Corps Dental Unit, a tertiary care military hospital at Srinagar between the year 2016 & 2017. At the time of enrolment age, gender, extent of injury and definitive diagnosis were recorded. Other information such as type of surgery, hospital stay was taken from in-patient hospital record documents. An informed consent was taken from all patients. A total of 16 patients (all males) with a mean age of 29.6 ± 4.2 years were part of our study. The average time interval between trauma and surgery was 7 to 10 days. There was striking high prevalance of mandibular injuries in 62.5% patients, 18.7% patients having combined maxilla-mandibular defects and 12.5% patients with injuries around the mid-face. Complications such as immediate airway compromise were seen in 50% of the patients who suffered direct airway trauma necessitating tracheostomy. The 43.7% patients suffered nerve injuries at the time of presentation while 56.2% patients suffered scar contracture noted at follow-up of 1 year. One patient suffered a stellate wound with ragged and torn edges and also trauma to the parotid gland. Other salivary gland injuries were also noted in 18.7% patients. Reconstruction using local flaps was done in 3 patients of our series. The mean duration of hospital stay was 43.3 ± 33.5 days. An average follow up ranged from 12 ± 6 months. Early and appropriate intervention to preserve and stabilise the facial skeleton and reconstruction of the facial soft tissue envelope in high-velocity ballistic injuries is highly effective and yields superior functional and esthetic outcomes.