The scattering of violence: A review of the global epidemiology and characteristics of maxillofacial firearm wounds.

Firearm Injury and Mortality Prevention in Pediatric Health-care Settings.

Objective: To describe the incidence, pattern, and severity of maxillofacial trauma among patients who sustained gunshot and blast injuries of the maxillofacial region in a tertiary military hospital. Methods: Design: Retrospective Case Series Setting: Tertiary Military General Hospital Participants: All patients admitted under the otorhinolaryngology service with gunshot and blast injuries to the face Results: A total of 108 patients were admitted due to gunshot and blast injuries to the face from January 2010 to December 2015. Most sustained gunshot injuries (73, 67.6%) compared to blast injuries (35, 32.4%). Of 108 patients, 71 had maxillofacial fractures (65.7%) while the remaining 37 only had soft tissue injuries (34.3%). Majority of those with maxillofacial fractures had single bone involvement (52, 72.2%); the rest had two or more bones affected (19, 27.8%) The most common bone injured was the mandible (77.5%), followed by the maxilla (35.2%), zygoma (12.7%), and others (frontal, nasal, and temporal bones) at 5.6%. Conclusion: Gunshot injuries had a higher incidence than blast injuries among military personnel with projectile injuries to the face seen during the study period. There were more fractures and combinations of fractured bones affected in gunshot injuries, although the breakdown of soft tissue injuries was similar among those with gunshot and blast injuries. However, the relation of injury patterns and severity to gunshot or blast etiology, or to other factors such as protective gear, cannot be established in this present study. Keywords: gunshot injuries; blast injuries; maxillofacial; projectile

Firearm injuries are now the leading cause of pediatric mortality in the United States. With the number of firearm injuries increasing at an alarming rate, the American Medical Association (AMA) declared firearm violence a public health crisis. In response to this emerging public health issue, the American College of Surgeons (ACS) developed the STOP THE BLEED training to educate laypersons on how to mitigate acute hemorrhage following gunshot wounds (GSWs) and other ballistic injuries. Stabilization of patients following GSWs is often handled by a multidisciplinary team of trauma and reconstructive surgeons. Here, we describe the history and ongoing role of reconstructive surgeons in preventing and addressing firearm morbidity and mortality. Hand surgeons are uniquely positioned to counsel patients on firearm safety, e.g., educating patients on proper firearm storage away from minors in the home, in an effort to mitigate accidental firearm injury to the upper extremity. As the evolving climate of firearm violence continues to rise, plastic and reconstructive surgeons will continue to play a critical role in restoring form and function among patients afflicted with GSWs.

Background:Evaluation and management of ballistic peripheral nerve injuries remain controversial, and recent series have suggested higher rates of nerve discontinuity than previously appreciated. Ultrasound (US) may aid clinicians in the management of ballistic injuries. The goal of this study was to compare US findings to electrodiagnostic and intraoperative findings to assess its accuracy in ballistic injuries.Methods:We conducted a retrospective review of patients with the following criteria: (1) ballistic injury to the upper or lower extremity with suspected mixed or motor peripheral nerve injury; (2) underwent electrodiagnostic studies (EDX) and peripheral nerve ultrasound. US findings were categorized as normal, enlarged, neuroma-in-continuity, partial transection, or complete transection. EDX were reviewed for abnormalities in compound motor action potential amplitudes.Results:Sixteen patients met our inclusion criteria, of whom 14 had US abnormalities: 8 neuromas-in-continuity, 2 complete transections/discontinuity, 1 partial transection, 2 enlargements, and 1 hypoechoic/fascicular irregularity. US detected 14 of 16 neurapraxic, axonotmetic, or neurotmetic peripheral nerve injuries after ballistic trauma. US had 88% sensitivity, with 0 false positives and 2 false negatives (negative on ultrasound, positive on electrodiagnostic testing) compared with electrodiagnostic testing.Conclusions:Our findings suggest that US is an accurate way to evaluate peripheral nerve injuries after ballistic trauma. US may play a role in early diagnostics, especially when EDX are of little value. Future work should focus on the accuracy of early US in ballistic injuries and determining the effects of US and EDX at varying time intervals.

Acquired hemophilia A (AHA), a rare but life-threatening disorder, most commonly occurs in older people and during pregnancy. During the coronavirus disease 2019 (COVID-19) vaccination campaign, an unexpected number of newly diagnosed AHA patients have been identified in clinical practice that were temporally related to COVID-19 vaccination. We present the result of a signal detection analysis aimed at exploring a possible association between COVID-19 immunization and occurrence of AHA. A disproportionality analysis on the World Health Organization (WHO) database was performed to investigate the presence of a signal of risk for AHA associated with COVID-19 vaccines. Reports of AHA associated with any COVID-19 vaccine included in the WHO database were then integrated with those available on the Food and Drug Administration Vaccine Adverse Events Reporting System and those published in the medical literature. The WHO database included 146 reports of AHA. The information component (IC) was significant for the association of AHA with all COVID-19 vaccines (IC025: 1.1) and with the vaccine product BNT162b2 (IC025: 1.6). After duplicate exclusion, 96 unique cases of AHA following COVID-19 vaccines have been reviewed. Median time to diagnosis was 18 days and 40% of cases documented the occurrence after the second dose. Overall, in 57% of the investigated cases, a preexisting condition predisposing to AHA was excluded. About 22% of cases occurred in subjects with age ≤65 years and there was no case associated with pregnancy. Mortality was 11%. Although we cannot exclude that the unexpected frequency of AHA diagnosis can be explained by a detection bias, the signal for COVID-19 vaccine-related AHA is robust and deserves further investigations.

The invasion of Ukraine by Russian troops on February 24, 2022, and the beginning of the full-scale war had huge humanitarian consequences. The major challenges facing the Ukrainian health care system included the disruption of medical infrastructure and logistics, the termination of the supply of expendable materials, significant migration, and a dramatic increase in high-velocity blast and gunshot injuries among combatants and civilians.The aim of the present study was to analyze the challenges and solutions in patient care faced by the Ukrainian system of maxillofacial surgery during the war in different regions of the country. A cross-sectional study was designed and implemented as an online survey to collect national data concerning maxillofacial surgeons' experiences and professional activities. The study was initiated and supported by Bogomolets National Medical University (Kyiv, Ukraine), the Ukrainian representative of AO CMF (Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial Surgery) and the University of Helsinki (Finland).The questionnaire was developed by specialists in maxillofacial surgery and sociologists and contained 65 close-ended questions. Surgeons who had not worked in this specialty in inpatient departments of hospitals since at least the beginning of the full-scale war were excluded from the study. We received and analyzed 97 responses that met the abovementioned criteria. The geography of respondents covered all the regions and the main cities of Ukraine, expect for the occupied territories. After a year of warfare, the percentage of surgeons who treated patients with blast and gunshot injuries increased from 43.4% to 86.6%. This percentage was higher in military hospitals and in regions located in the vicinity of the front line. We found that, during the war, 78.6% of respondents performed osteosynthesis in cases of high-velocity multifragmented facial bone fractures (in such cases, 58.3% of them strictly followed AO CMF recommendations, while 41.7% performed the fixation based on available hardware, existing technical possibilities and their own preferences). We found that 70.2% of respondents had the opportunity to apply Computer-Aided Design/Computer-Aided Manufacture technology and patient-specific implants for the treatment of gunshot injuries, 38.1% reported that their hospitals were able to perform microsurgical reconstructions for facial defects, 79.4% of respondents reported that their departments received humanitarian aid and support from volunteer organizations (either Ukrainian or international), which significantly facilitated the treatment process. According to this nationwide survey of Ukrainian maxillofacial surgeons during a year of the full-scale war, 86.6% of respondents were involved in the treatment of gunshot and ballistic injuries in civilians and combatants. The main problems reported by the respondents were (1) a lack of experience and knowledge related to the treatment of severe wounds, especially by secondary reconstruction, and (2) a deficit of resources (equipment, materials, and medications) under conditions of disrupted logistics and changes in the numbers and nosological distribution of patients. There were the opportunity to transfer the patients to European clinics (29.9%), online consultations (45.4%), collaboration with foreign surgeons who come to Ukraine asvolunteers (32%).

Maxillofacial ballistic trauma represents a devastating functional and aesthetic trauma. The extensive damage to soft and hard tissue is unpredictable, and because of the diversity and the complexity of these traumas, a systematic algorithm is essential. This study attempts to define the best management of maxillofacial ballistic injuries and to describe a standardized, surgical and prosthetic rehabilitation protocol from the first emergency stage up until the complete aesthetic and functional rehabilitation. In low-velocity ballistic injuries (bullet speed <600 m/s), the wound is usually less severe and not-fatal, and the management should be based on early and definitive surgery associated with reconstruction, followed by oral rehabilitation. High-velocity ballistic injuries (bullet speed >600 m/s) are associated with an extensive hard and soft tissue disruption, and the management should be based on a three-stage reconstructive algorithm: debridement and fixation, reconstruction, and final revision. Rehabilitating a patient with ballistic trauma is a multi-step challenging treatment procedure that requires a long time and a multidisciplinary team to ensure successful results. The prosthodontic treatment outcome is one of the most important parameters by which a patient measures the restoration of aesthetic, functional, and psychological deficits. This study is a retrospective review: twenty-two patients diagnosed with outcomes of ballistic traumas were identified from the department database, and eleven patients met the inclusion criteria and were enrolled.

Mass casualty incidents (MCIs) involving extensive ballistic and explosive injuries place considerable pressure on healthcare resources. This study aimed to evaluate the rehabilitation resources required for individuals who sustained blast and ballistic injuries during an MCI. A retrospective review was conducted using Electronic Medical Records (EMRs) of patients admitted to Sheba Medical Center (SMC), Israel, following an MCI on 7 October 2023. Patients diagnosed with gunshot wounds (GSW), or blast injuries (BI) were included. Data were collected over an almost 7-month period, focusing on injury patterns, rehabilitation department admissions, total hospital length of stay, and associated budgetary requirements. A total of 419 patients received rehabilitation at SMC: 205 with BI, 175 with GSW, 10 with both, and 9 with unknown injury causes. Two patients were under 18; the majority (76 %) of adults were aged 18-29. Military personnel comprised 90 % of the cohort, with 95 % male. Paediatric rehabilitation admitted the two minors, while adult patients were distributed across respiratory (n = 7), neurological (n = 32), head trauma (n = 44), and orthopaedic (n = 68) rehabilitation units. Additionally, 266 patients were treated in three newly established rehabilitation wards. BI patients experienced more complex, multi-trauma injuries, including traumatic brain injuries (11 %) and spinal cord injuries (11 %), underwent more surgical procedures, and had longer hospital stays. Consequently, the average rehabilitation cost per BI patient exceeded that of GSW patients. Through strategic planning and multidisciplinary collaboration, SMC effectively managed a high volume of MCI-related injuries. BIs required significantly more rehabilitation resources than GSWs. These findings underscore the importance of preparedness, resource allocation, and interdepartmental coordination in managing rehabilitation during MCIs. SMC's experience offers valuable insights for global healthcare systems facing similar high-demand emergency scenarios.

Background: Tuberculosis remains a major global health problem with 10.4 million incident cases in 2016. Although Mycobacterium tuberculosis is the causative agent, many environmental factors play a role in disease progression. Several respiratory hazards including smoking and indoor air pollution were suggested to increase the risk of tuberculosis, but only fewer studies has been conducted on the association between ambient air pollution and tuberculosis.Methods: Data on ambient air quality levels (annual mean concentration of particulate matter 2.5 µg/m3) for the year 2016 was collected from the World Health Organization (WHO) data base for 190 countries which comprises of 6 WHO regions. Similarly data on incidence and mortality rate of tuberculosis for the year 2016 was collected for the above countries from the WHO data base. The data were tabulated and statistical analysis was performed using Pearson’s correlation coefficient model to examine the association of annul mean concentration of particulate matter 2.5 with incidence and mortality rates of tuberculosis.Results: Incidence and mortality rates of tuberculosis were found to be increasing with increasing levels of air pollution. It was correlated using scatter plot. Pearson’s correlation coefficient for air pollution level and incidence of tuberculosis was 0.331 (95% CI: 0.435-0.883), (p&lt;0.001), and for tuberculosis mortality was 0.39 (95% CI: 0.525-0.906) (p&lt;0.001).Conclusions: The study suggests there is a significant positive relationship between ambient air pollution level and tuberculosis incidence and mortality rates.

To determine the risk factors associated with the development of hyponatremia during treatment with antidepressant drugs, we conducted a retrospective register study of the World Health Organization (WHO) data base for spontaneous reporting of adverse drug reactions. From the start of the WHO Collaborating Centre for International Drug Monitoring in 1968 until the end of 1993, 668 reports of antidepressant-associated hyponatremia disorders were submitted. Seventy-eight percent of them concerned women, compared with 69% for all other adverse drug reactions with antidepressants (p < 0.0005). The mean age of all patients was 66.6 years, compared with 48.6 years for the other adverse drug reactions (p < 0.0001). In 51.3% of the patients the reaction occurred within the first 2 weeks of treatment. Significantly more cases occurred during the summer than during the other seasons (p < 0.02). The risk for hyponatremia during treatment with antidepressants seems to be highest in women, in the elderly, during the summer, and during the first weeks of treatment.

Colyer describes the management of a heterogeneous group of ballistic facial injuries and as such his term ‘ gunshot injuries ’ is perhaps incorrect and ‘ballistic injury’ would be more...

To evaluate whether ballistic (gunshot) injuries increase the rate of severity of heterotopic ossification (HO) compared with blunt trauma in patients with periarticular elbow fractures. Retrospective cohort. Single Level 1 trauma center. Study inclusion required patients of mature skeletal age diagnosed with a periarticular elbow fracture (OTA/AO 13A-C) with a minimum of 6 weeks radiographic follow-up between 2018 and 2024. Data on demographics, injury characteristics, and surgical management were collected for the ballistic trauma cohort and blunt trauma cohort. HO was assessed using the Hastings/Brooker Classification. Secondary outcomes included postinjury stiffness defined as a flexion/extension arc of motion <100 degrees, revision surgery, and complications. Descriptive statistics were used to compare frequencies of categorical outcome variables between blunt and ballistic cohorts, and multivariable logistic regressions were used to identify risk factors for elbow HO occurrence and severity and all secondary outcomes. A total of 171 patients met inclusion criteria including 65 Gunshot Wound (GSW)-related fractures (38%). Patients with GSW were younger [29.2 (range: 18-62) vs. 43.8 years (range: 18-93)] and more often male (84.6% vs. 51.9%). Overall HO occurrence was 61.4%. GSW was not significantly associated with HO (63.1% vs. 60.4%, P = 0.607). Distal humerus fractures were associated with increased HO risk [odds ratios (OR) 2.15] and severity (OR 2.63) compared with proximal radius/ulna injuries. Stiffness occurred in 73.7% of patients and was more common in distal humerus injuries than in proximal radius/ulna fractures (OR 2.50; P = 0.030). No significant differences were found in stiffness, revision surgery, or complication rates between GSW and non-GSW groups (OR 1.36; 95% CI: 0.537-3.455; P = 0.51). Ballistic injury did not significantly increase HO risk or stiffness compared with blunt trauma in a civilian population. Consistent with the literature, fracture location, specifically distal humerus fractures compared with proximal radius/ulna injuries, seems to be an important driver for HO prevalence and severity. Identifying HO risk factors after periarticular elbow trauma can help clinicians stratify patient risk and guide preventive strategies for managing these complex injuries. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Microvascular free tissue transfer is often employed to reconstruct significant facial defects from ballistic injuries. Herein, we present our comparison of complications between self-inflicted and non-self-inflicted gunshot wounds after microvascular free tissue transfer. Retrospective case review. Approval was obtained from the JPS institutional review board. We performed a retrospective review of cases of ballistic facial injuries between October 1997 and September 2017 that underwent vascularized free tissue transfer for reconstruction. Comparisons were made between self-inflicted and non-self-inflicted gunshot wounds after microvascular free tissue transfer. The χ2 test was used for all comparisons. P value and 95% confidence interval (CI) were reported. There were 73 patients requiring free flap reconstruction after gunshot wounds to the face during the study period. There was a statistically significant difference in the rates of nonunion between self-inflicted and non-self-inflicted wounds (P = .02, 95% CI: 0.9 to 35.8) There were also no significant differences in flap failure (P = .10, 95% CI: -2.8 to 24.2), plate exposure (P = .28, 95% CI: -6.7 to 33.0), wound infection (P = .40, 95% CI: -8.9 to 31.2), scar contracture (P = .60, 95% CI: -8.1 to 25.1), and fistula formation (P = .13, 95% CI: -2.8 to 28.8) between patients with self-inflicted and those with non-self-inflicted wounds. Overall, complication rates were significantly higher in the self-inflicted group compared to the non-self-inflicted group (P < .0001, 95% CI: 32.6 to 68.6). Patients with self-inflicted injuries had more complications postoperatively than those with non-self-inflicted injuries. This is likely helpful in surgical planning and patient counseling. 4 Laryngoscope, 129:837-840, 2019.

The aim of the study was to identify the periodontal status of Szczecin citizens using the Community Periodontal Index (CPI), and to compare the results with those from selected European and world countries using the World Health Organization (WHO) database. A sample of 250 patients was randomly selected using two-stage stratified sampling among people living in Szczecin aged 35-44 years. Participants were examined using the WHO CPI score at the Department of Periodontology, Pomeranian Medical University in Szczecin. Scores were compared with findings from previous research carried out in Poland and other countries. That only 4.4% of respondents had a healthy periodontium (5.76% of women and only 2.7% of men). Bleeding gums after probing (17.99%) and the presence of calculus (20.14%) were more frequently reported in women. The largest percentage of respondents (44.8%) had periodontal pockets 3.5-5.5 mm deep, with more women (45.32%) than men (44.14%). In contrast, more men (25.23%) had deep periodontal pockets at least 6 mm deep, with only 10.79% in women. A survey conducted across Poland in 1987 showed 0.7% of people with a healthy periodontium which rose to 6.3% in 1995. Compared to studies available in the WHO database, the number of people with a healthy periodontium, i.e. CPI = 0 is lower than in Japan (18%) and Spain (15%), but higher than in the United Kingdom (4%) and China (0%). Findings from the study indicate an increasing percentage of people in Poland suffering from periodontal disease. This brings us closer to results obtained in developed countries around the world.

Studies on the concept of Damage Control Surgery (DCS) in the management of firearm injuries to the oral and maxillofacial region are still scarce, hence the basis for the current study. The objectives of the current study is to share our experience in the management of maxillofacial gunshot injuries with emphasis on DCS and early definitive surgery. This was a retrospective study of combatant Yemeni patients with maxillofacial injuries who were transferred across the border from Yemen to Najran, Kingdom of Saudi Arabia. Demographics and etiology of injuries were stored. Paths of entry and exit of the projectiles were also noted. Also recorded were types of gunshot injury and treatment protocols adopted. Data was stored and analyzed using IBM SPSS Statistics for Windows Version 25 (Armonk, NY: IBM Corp). A total of 408 victims, all males, were seen during the study period with 173 (42.4%) males sustaining gunshot injuries to the maxillofacial region. Their ages ranged from 21 to 56 years with mean ± SD (27.5 ± 7.6) years. One hundred and twenty-one (70.0%) victims had extraoral bullet entry, while 53 (30.0%) victims had intraoral entry route. Ocular injuries, consisting of 25 (14.5%) cases of ruptured globe and 6 (3.5%) cases of corneal injuries, were the most commonly associated injuries. A total of 78 (45.1%) hemodynamically unstable victims had DCS as the adopted treatment protocol while early definitive surgery was carried out in 47(27.2%) hemodynamically stable victims. ORIF was the treatment modality used for the fractures in 132 (76.3%) of the victims. We observed that 42.4% of the war victims sustained gunshot injuries. DCS with ORIF was the main treatment protocol adopted in the management of the hemodynamically unstable patients.