Facial injuries in Iranian veterans during the Iraq–Iran war (1980–88): differences from recent conflicts

Orbital in juries in wartime: Historical study from Paul Tessier's work in Iran

INTRODUCTION

Paul Tessier was a leading French oculoplastic surgeon who took part in several surgical missions in Iran to manage victims of the Iraq-Iran conflict in the late 1980's and early 1990's.

METHODS

We collected the records of 322 patients who underwent surgical procedures for the management of wartime injuries by Paul Tessier's team in Iran from 1990 to 1993. We also report one of the most representative cases of orbital reconstruction performed by Tessier.

RESULTS

Mean age at the time of trauma was 20.65±7.04 years (range: 2--62). Craniofacial CT-scans were available for 54 patients. The bones of the upper third of the face and the orbital contents were affected in 124/322 patients (38.50%). Soft-tissue lesions of the upper third included 13 frontal lacerations (4.04%), 60 orbital injuries (18.63%) and 95 uni- or bilateral enucleations (29.50%). Thirty-nine uni- or bilateral lid injuries (12.11%) and 8 tear duct injuries (2.48%) were reported. A specific case of orbital reconstruction using antero-internal and posterior iliac bone grafts was reported as a representative example of Tessier's techniques.

CONCLUSION

This study highlights the challenges of orbital reconstruction in wartime injuries and provides insights on the work of one of the most renowned surgeons in this field.

[Ballistic trauma of the face: A new scourge in Tunisia]

INTRODUCTION

Ballistic trauma of the face has aroused growing interest since the proliferation of conflicts in the world and particularly in the fight against terrorism. Their polymorphous and disfiguring character, their particular evolution and prognosis due to the ballistic aetiology, differentiate them from classic maxillofacial trauma. Tunisia did not escape this scourge after the revolution of 2011, and must therefore face the challenge of ballistic trauma in general and of the face in particular.

MATERIALS AND METHODS

We conducted a descriptive retrospective study on 30 patients who were victims of ballistic trauma of the face in the otolaryngology and maxillofacial surgery and ophthalmology departments of the Main Military Hospital of Tunis during the period from January 2011 to April 2018. Our objective was to assess the prevalence of these traumas in Tunisia after the revolution, and to assess their clinical and therapeutic aspects.

RESULTS

Our results showed a clear upward trend in these traumas, mainly caused by the opposition of our armed forces to the terrorist threat. The discussion of our results was therefore descriptive, comparing them to the literature.

CONCLUSION

Currently, it is imperative to develop a strategy for precise and effective management of ballistic trauma of the face due to the increase of armed conflicts, attacks and terrorist acts. Likewise, technological advances to develop soldier protection systems must be implemented.

Maxillofacial surgery in wartime Middle-East: Paul Tessier's missions to Iran

The Iraq-Iran war (1980-88) resulted in numerous maxillofacial injuries. More than 400,000 people were wounded and required specialist care. Paul Tessier, a leading French plastic surgeon and pioneering craniofacial surgeon, was involved in several missions to Iran and operated on a vast cohort of patients with complex war trauma sequelae. Our study included 322 files relating to patients with war injuries operated on by Paul Tessier in Iran from 1990 to 1993. The files were the property of the Association Française des Chirurgiens de la Face. Relevant epidemiological parameters and data on surgical indications and procedures were collected. Descriptive statistics were used in order to characterize the cohort, and a multivariate logistic model was developed in order to assess factors associated with severe eye injuries within all facial injuries. Age range at admission was 5-67 years (average: 27.15 ± 6.97). The most common trauma mechanisms were shell fragments (161 patients; 50 %) and bullets (27 patients; 8.38 %). The bone and orbital contents in the upper third of the face were affected in 124 patients (38.50%); 72 patients (22.36%) had trauma of the middle third of the face; and 86 patients (26.71%) had trauma of the lower third. A total of 175 bone grafts were harvested by Tessier: 72 (41.14%) iliac grafts and 94 (53.71%) frontal and/or parietal grafts. Tessier managed 60 orbital fractures (18.63%) and 95 patients with uni- or bilateral enucleations (29.50%). A multivariate logistic model showed that patients injured by shells were 4.04 (1.32; 17.60) more likely (p = 0.03) than patients with gunshot wounds to have had uni- or bilateral enucleation, regardless of age and gender. Tessier's files provide first-hand information on the injury patterns that resulted from a regional war in the 1980s, and on the reconstruction challenges faced by a country during its post-war recovery period.