Rocket-Propelled Grenade Maxillofacial Injuries and Management

Thermal shell fragment craniofacial injury: biophysics, pathophysiology, and management

This article aims to bring attention to unique risks and burns by thermal shell fragment craniofacial soft tissue injury. Hot shrapnel may inflict burns to major vessel walls and lead to life-threatening hemorrhaging or death, which adds a new challenge for craniofacial surgeons. Morbidity of thermal deep tissue may lead to deep tissue necrosis and infection.Thermal energy (TE) physics, biophysics, and pathophysiological effects relate directly to the amount of heat generated from shell casing detonation, which transfers to skin, deep tissue, as well as brain and leads to life-threatening burning of organs; this is different from shrapnel kinetic energy injury.The unprecedented increase in using a large range of explosives and high-heat thermobaric weapons contributes to the superfluous and unnecessary suffering caused by thermal injury wounds.Surgeons and medics should recognize that a surprising amount of TE can be found in an explosion or detonation of a steel-encased explosive, resulting in TEs ranging from 400 F up to 1000 F.

Management of penetrating medial and retro-bulbar orbital shrapnel/bullet injuries

The presence of shrapnel or a bullet lying in the medial orbital and retrobulbar area is rare. A review of the literature revealed only a few reports. Recently eye/orbital penetrating trauma has increased dramatically, mainly due to IEDs or conventional weaponry in civilian and military casualties. Our experience in the management of these types of injuries prompted this report. Practical techniques for correctly determining the location of retained projectiles in the orbit are described. Surgical techniques for treatment are presented, based on safe and successful practices used in the missile retrievals. Six shrapnel and three bullet injuries, mostly in the medial orbital region, were removed without increasing morbidity and with limited orbital tissue injury.

Orofacial infections in Iraq

In Iraq, oral and maxillofacial (OMF) infections are common; these infections may be of odontogenic or nonodontogenic origin. The former, the commoner, gains importance from the catastrophic consequences that may take place in neglected or mismanaged patients and, as a paradox, from a fact that most of these infections are avoidable and preventable if a timely and accurate management took place for the primary dental problem. Nonodontogenic infections are not uncommon and are of life-threatening potential. Most of these infections are associated with an underlying medical condition that, whenever controlled, can help achieve acceptable results. Although missile injuries-associated infections are almost exclusively of bacterial origin, a separated section is assigned in this article for these infections, in addition to other varieties of bacterial, viral, and fungal infections. The article gives an account of common presentations, diagnostic procedures, treatment protocols, and outcomes of management of OMF infections in Baghdad's central OMF surgery department. These infections are considered as one of the elementary problems in OMF clinics; thus, highlighting significant points extirpated from an overall view of a more than 10-year experience can suggest where shortcomings in management are and can pave the way for future improvement.

Maxillofacial air-containing cavities, blast implosion injuries, and management

PURPOSE

Distinctive mechanisms of primary blast effects have produced a transitional era of facial trauma. Implosion mechanism damage is one of these. Implosion mechanism damage results in injury limited to the gas-containing structures of the auditory canal, paranasal sinuses, gastrointestinal tract, and lungs. Worldwide, the victims of explosive detonations have increased and advanced dramatically. The outcome is greater mortality and morbidity and new types of injuries, especially in the maxillofacial region. Thus, the knowledge of, and experience with, their management should be shared globally by colleagues through publications.

MATERIALS AND METHODS

The implosion and mini re-explosion of compressed air sinuses leads to skeletal crush injury to the nasal-orbital-ethmoidal, maxillary sinuses, and nasal bones. A variety of surgical approaches were used successfully under conditions of war. The assessment of the associated injuries to the lung and/or brain is the initial priority to any life-threatening blast injury. This article describes the biophysical results of blast injuries to the middle third facial skeleton and associated injuries and details the management and protection of crushed air containing paranasal spaces.

RESULTS

Easy, simple, and fast treatment and management were used successfully on the pulverized, fragmented skeletal architecture of the facial middle part without increasing morbidity and with the avoidance of unnecessary surgical trauma.

CONCLUSIONS

Injuries in one of the most difficult esthetic, physiologic, and anatomic regions of the body is best treated with an understanding of the biophysical effects of the implosion mechanism on air-containing spaces in the maxillofacial region. The introduction of new methods for the management of severe destruction of hard and soft tissue will decrease the incidence of complications and the operative time.