Management of self-inflicted gunshot (pellet) wounds of the jaws with Le fort I osteotomy followed by implant insertion and prosthetic rehabilitation

Abstract

Background: Gunshot injuries to maxillofacial complex can result from suicide, rarely patients can survive. Those wounds can result in devastating functional and aesthetic consequences because of the missing hard and soft tissues. Objective: We would like to present the treatment of a case who had self-inflicted injury with severe tissue loss. A 43-year-old man was sent to our clinic from the Plastic Surgery Department 4 months after his initial admission with several scar formations in soft tissues, a missing left eye and a smashed mandible which had been reconstructed. Half of the tongue, floor of the mouth and most of the maxilla were destroyed on the left side. The fractures of the right maxilla had healed in a retruded position; the vertical height of the face was shortened, resulting in a cross bite, causing a deviation to right. We advanced the maxilla with Le fort I osteotomy to establish the vertical dimension with the aid of the upper and lower molars. Dental and orthodontic implants, an obturator prosthesis to the maxilla and an implant-supported prosthesis to the mandible were applied. We achieved the restoration of function and emotional comfort to the patient. Findings and conclusions: Management of gunshot wounds of the maxillofacial region represents formidable challenge to the surgeon. The type and severity of the injury and success of the treatment depend on the gun type, projectile velocity and tissue resistance. The most difficult problems are secondary infection, severe deformity and tissue volume loss.