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Hamilton JM, Chan TG, Moore CE. Penetrating Head and Neck Trauma: A Narrative Review of Evidence-Based Evaluation and Treatment Protocols. Otolaryngol Clin North Am 2023; 56:1013-1025. [PMID: 37353366 DOI: 10.1016/j.otc.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023]
Abstract
Penetrating injury to the head and neck accounts for a minority of trauma but significant morbidity in the US civilian population. The 3-zone anatomical framework has historically guided evaluation and management; however, the most current evidence-based protocols favor a no-zone, systems-based approach. In stable patients, a thorough physical examination and noninvasive imaging should be prioritized, with surgical exploration of the head and neck reserved for certain circumstances. Diagnostic and management decisions should be tailored to the mechanism of injury, history, physical examination, experience of personnel, availability of equipment, and clinical judgment.
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Affiliation(s)
- James M Hamilton
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Grady Memorial Hospital, Atlanta, GA, USA.
| | - Tyler G Chan
- Emory University School of Medicine, Atlanta, GA, USA
| | - Charles E Moore
- Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Grady Memorial Hospital, Atlanta, GA, USA
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2
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Wamkpah NS, Kimball A, Pipkorn P. Evidence-Based Medicine for Ballistic Maxillofacial Trauma. Facial Plast Surg 2023; 39:237-252. [PMID: 36929067 DOI: 10.1055/s-0043-1764347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Ballistic trauma is a serious health issue with significant costs to physical, psychosocial, economic, and societal well-being. It may be caused from firearms, explosive devices, or any other projectile forces, and is characterized by severe tissue loss and evolving tissue devitalization. This review covers mechanism, diagnosis, and management of ballistic maxillofacial trauma, specifically. Initial evaluation includes stabilization of airway, bleeding, and circulation, followed by assessment of other injuries. The overall degree of tissue damage is determined by intrinsic patient factors and extrinsic projectile factors. Management of ballistic injuries has shifted toward advocation for early operative repair with the advent of antibiotics and advanced techniques in maxillofacial reconstruction. Appropriate timing and method of reconstruction should be carefully selected on a case-by-case basis. While ballistic trauma research is limited to studies biased by institutional practices, areas for further study identified from current literature include guidelines directing timing of reconstructive surgery; thresholds for free tissue transfer; handling of retained projectiles; incidence of surgical complications; and clinical outcomes for computer-aided surgical repair of these highly destructive injuries.
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Affiliation(s)
- Nneoma S Wamkpah
- Department of Otolaryngology, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Abby Kimball
- InPrint, Washington University in St Louis School of Medicine, St Louis, Missouri
| | - Patrik Pipkorn
- Department of Otolaryngology, Washington University in St Louis School of Medicine, St Louis, Missouri
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Qaisi M, Martin S, Al Azzawi T, Aldelayme R, Bokhari F, Murphy J. Is Maxillofacial Gunshot Wound Location Associated With Operative Intervention? J Oral Maxillofac Surg 2022; 81:434-440. [PMID: 36592933 DOI: 10.1016/j.joms.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 12/04/2022] [Accepted: 12/07/2022] [Indexed: 12/31/2022]
Abstract
PURPOSE Gunshot wound (GSW) injuries are an important public health concern in the United States. The study purpose was to measure the association between GSW location and need for operative treatment. METHODS This was a retrospective cohort study. Sample consisted of all patients treated for maxillofacial gunshot wound injuries at Cook County Health from 2008 to 2018. The sample data were collected through a retrospective charts review and review of computed tomography imaging. The predictor variable was the region of the face involved with the GSW and it was divided into 3 levels, upper face (UF), middle face (MF), and lower face (LF). The outcome variable was whether operative intervention was rendered or not (operative vs no intervention). Other variables of interest collected included patient demographics, the type of surgical intervention, disposition (home vs rehab/morgue), rate of intracranial injury, and need for blood transfusion. Data analysis was performed using Chi-square for proportions and relative risk (RR) with 95% confidence interval (CI). RESULTS A total of 180 patients were identified to have sustained GSW injuries to the face during abovementioned time frame. Of those, 120 patients had isolated GSW injuries with no other organs involvement. The median age was 25 years. Majority of the patients were males (94%). The involved facial region appeared to influence the need for operative management and this reached statistical significance (Chi-square 22.703, P < .001). GSW injuries to LF were 2.94 times more likely to require operative intervention than injuries to the MF (RR = 2.94, 95% CI = 1.625-5.327). Injuries of the UF were 2 times more likely to require operative intervention than injuries of the MF (RR = 2.03, 95% CI 1.023-4.008). Injuries to the UF were more likely to be associated with intracranial injuries (Chi-square = 20.522, P < .001). CONCLUSIONS In patients with facial GSW injuries, there is an association between injury location and the need for operative intervention. Injuries to the LF were most likely to require surgical intervention followed by the UF and MF, respectively.
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Affiliation(s)
- Mohammed Qaisi
- Professor of Oral and Maxillofacial Surgery, Midwestern University and Program Director, Division of Oral and Maxillofacial Surgery, Cook County Health, Chicago, IL.
| | - Stephen Martin
- Oral and Maxillofacial Surgery, Cook County Health, Chicago, IL
| | - Thaer Al Azzawi
- Research Fellow, Division of Oral and Maxillofacial Surgery, Cook County Health, Chicago, IL
| | - Raed Aldelayme
- Research Fellow, Division of Oral and Maxillofacial Surgery, Cook County Health, Chicago, IL
| | - Faran Bokhari
- Director Department of Trauma/Burn Surgery and Rehabilitation, Cook County Health, Chicago, IL
| | - James Murphy
- Associate Professor (MWU), Division of Oral and Maxillofacial Surgery, Cook County Health, Chicago, IL
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Daniels JS, Albakry I, Braimah RO, Samara MI, Albalasi RA, Al-Rayshan SM. Management of Maxillofacial Gunshot Injuries With Emphasis on Damage Control Surgery During the Yemen Civil War. Review of 173 Victims From a Level 1 Trauma Hospital in Najran, Kingdom of Saudi Arabia. Craniomaxillofac Trauma Reconstr 2022; 15:58-65. [PMID: 35265279 PMCID: PMC8899348 DOI: 10.1177/19433875211012211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Study Design 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. Objectives 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. Methods 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). Results 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. Conclusions 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.
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Affiliation(s)
- John S. Daniels
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
| | - Ibrahim Albakry
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
| | - Ramat O. Braimah
- Department of Oral and Maxillofacial Surgery, Specialty Regional Dental Center, Najran, Kingdom of Saudi Arabia,Ramat O. Braimah, FWACS, Department of Oral and Maxillofacial Surgery, Specialty Regional Dental Center, Najran, Kingdom of Saudi Arabia.
| | - Mohammed I. Samara
- Department of Oral and Maxillofacial Surgery, King Khalid Hospital, Najran, Kingdom of Saudi Arabia
| | - Rabea A. Albalasi
- Department Oral and Maxillofacial Surgery, Sharorah General Hospital, Kingdom of Saudi Arabia
| | - Saleh M.A. Al-Rayshan
- Department of Oral and Maxillofacial Surgery, Khobash General Hospital, Khobash, Saudi Arabia
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Al-Ahmady HH, El Sayed M, Fereir A, Ekram A, Mousa K. Removal of large impacted foreign body from the base of the skull through submandibular access: A multidisciplinary approach. Int J Surg Case Rep 2018; 50:21-24. [PMID: 30071376 PMCID: PMC6080633 DOI: 10.1016/j.ijscr.2018.07.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/02/2018] [Accepted: 07/14/2018] [Indexed: 11/23/2022] Open
Abstract
Cut wounds in the face, should be repaired after proper investigations. Trismus following trauma should be managed seriously. Removal of a foreign body from the maxillofacial region should be managed with Multidiscplinary team approach.
Introduction This report describes the removal of a missed impacted large piece of a glass that reaches the infra-temporal region after a traumatic injury at the submandibular area. Case presentation A nine year-old patient presented with a limited mouth opening (0.5 cm). Initial examination showed a scar of an old trauma in the submandibular area two months prior to presentation. The radiographic study showed a large knife-shaped foreign body with its tip at the infra-temporal region, and its base at the submandibular region. Further multi-slice computed tomography with angiography was done that showed close proximity of the foreign body to the branches of the external carotid artery; maxillary, lingual and facial branches. The foreign body was removed via extra-oral approach through the old scar of the past injury under general anesthesia. Dissection, exposure of the external carotid artery and preparing it for emergency ligation, were done before extraction of the foreign body. The patient’s mouth opening increased to 2.5 cm without any complications. Conclusion Cut wounds in the face should not be repaired in the primary care without detailed history, systematic examination and proper investigations.
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Affiliation(s)
- Hatem H Al-Ahmady
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry (Girls), Al Azhar University, cairo, Egypt
| | - Mohamed El Sayed
- Department of Otolaryngology-Head and Neck Surgery, Faculty of Medicine, Banha University, Banha, Egypt
| | - Ahmed Fereir
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Future University, End of 90th St., Fifth Settlement, New Cairo, Cairo, Egypt.
| | - Amr Ekram
- Oral and Maxillofacial Radiology, Ekram Center for Oral Radiology and Computer Assisted Surgeries, Cairo, Egypt
| | - Kareem Mousa
- Department of Radio-Diagnosis, Faculty of Medicine, Cairo University, Cairo, Egypt
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Management of self-inflicted gunshot wounds to the face: retrospective review from a single tertiary care trauma centre. Br J Oral Maxillofac Surg 2018; 56:173-176. [DOI: 10.1016/j.bjoms.2017.12.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 12/31/2017] [Indexed: 11/17/2022]
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Traumatic Foreign Body into the Face: Case Report and Literature Review. Case Rep Dent 2017; 2017:3487386. [PMID: 28127474 PMCID: PMC5239829 DOI: 10.1155/2017/3487386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Revised: 11/18/2016] [Accepted: 12/14/2016] [Indexed: 11/17/2022] Open
Abstract
This paper describes a case of mouth opening limitation, secondary to a facial trauma by cutting-piercing instrument, whose fragments had not been diagnosed in the immediate posttrauma care. Description of an unusual surgical maneuver and a literature review are presented.
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Malaga EG, Aguilera EMM, Eaton C, Ameerally P. Management of Self-Harm Injuries in the Maxillofacial Region: A Report of 2 Cases and Review of the Literature. J Oral Maxillofac Surg 2016; 74:1198.e1-9. [PMID: 27000411 DOI: 10.1016/j.joms.2016.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Revised: 02/19/2016] [Accepted: 02/21/2016] [Indexed: 10/22/2022]
Abstract
Clinicians face numerous challenges when managing psychiatric patients who self-inflict injuries within the maxillofacial region. In addition to a complex clinical examination, there are both surgical and psychiatric factors to consider, such as the risk of damaging vital structures, the exacerbation of the patient's psychiatric status, and the long-term psychosocial and esthetic sequelae. We present 2 cases of adolescents who repeatedly self-inflicted wounds and/or inserted foreign bodies (FBs) into the face, scalp, and neck. The different treatment modalities were based on full evaluation of the patient's clinical, medical, and diagnostic test findings coupled with a psychiatric assessment. The decision for conservative management or surgical intervention was made according to the presence and location of the FBs, degree of hemorrhage, signs and symptoms of infection, and unpleasant scars that could lead to long-term psychological impairment. In most cases, the FBs were removed and the wounds were toileted and closed under local or general anesthesia. We advocate a holistic approach via a multidisciplinary team, which is deemed essential to provide the highest quality of care for patients to reduce the risk of further relapses. Lastly, a satisfactory esthetic outcome is always paramount to achieve long-term psychological and physical welfare.
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Affiliation(s)
| | | | - Carolyn Eaton
- Dental Core Trainee, OMFS Department, Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Phillip Ameerally
- Consultant in Oral and Maxillofacial Surgery, OMFS Department, Northampton General Hospital, Northampton, United Kingdom
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Late Oropharyngeal Functional Outcomes of Suicidal Maxillofacial Gunshot Wounds. J Craniofac Surg 2015; 26:691-5. [DOI: 10.1097/scs.0000000000001588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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10
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Arzi B, Verstraete FJ. Internal Fixation of Severe Maxillofacial Fractures in Dogs. Vet Surg 2014; 44:437-42. [DOI: 10.1111/j.1532-950x.2014.12161.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 12/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Boaz Arzi
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California; Davis California
| | - Frank J.M. Verstraete
- Department of Surgical and Radiological Sciences; School of Veterinary Medicine; University of California; Davis California
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Kalantar Motamedi MH. Comprehensive Management of Maxillofacial Projectile Injuries at the First Operation; "Picking up the Pieces". Trauma Mon 2013; 17:365-6. [PMID: 24350127 PMCID: PMC3860666 DOI: 10.5812/traumamon.9279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Accepted: 11/26/2012] [Indexed: 11/16/2022] Open
Affiliation(s)
- Mohammad Hosein Kalantar Motamedi
- Department of Oral and Maxillofacial Surgery, Trauma Research Center, Baqiyatallah Medical Sciences University, Tehran, IR Iran
- Corresponding author: Mohammad Hosein Kalantar Motamedi, Department of Oral and Maxillofacial Surgery, Trauma Research Center, Baqiyatallah Medical Sciences University, Tehran, IR Iran. Tel.: +98-9121937154, Fax: +98-2188053766, E-mail:
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12
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Dominguete PR, Matos BF, Meyer TN, Oliveira LR. Jael syndrome: removal of a knife blade impacted in the maxillofacial region under local anaesthesia. BMJ Case Rep 2013; 2013:bcr-2013-008839. [PMID: 23580680 DOI: 10.1136/bcr-2013-008839] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The presence of retained foreign bodies in the maxillofacial region as a consequence of penetrating injuries from knives is poorly documented in the scientific literature. This manuscript reports the case of a 30-year-old Caucasian with a knife blade lodged in the maxillofacial skeleton. Following clinical and radiographic exams, it was determined that the object had penetrated through the left nostril and nasal septum, in the direction of the right maxillary sinus, and remained impacted without causing injury to important anatomical structures. After systemic assessment and determination of the exact location of the knife blade, the object was removed in an outpatient setting under local anaesthesia. This manuscript aims to report a rare case of a transfacial penetrating injury involving a knife blade that was removed in an outpatient setting while also discussing the proper conduct and treatment options for similar cases in the context of a brief literature review.
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Arunkumar KV, Kumar S, Aggarwal R, Dubey P. Management challenges in a short-range low-velocity gunshot injury. Ann Maxillofac Surg 2013; 2:200-3. [PMID: 23482828 PMCID: PMC3591059 DOI: 10.4103/2231-0746.101367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The use of firearms is becoming more prevalent in the society and hence the number of homicidal and suicidal cases. The severity of gunshot wounds varies depending on the weapons caliber and the distance of firing. Close-range, high-velocity gunshot wounds in the head and neck region can result in devastating esthetic and functional impairment. The complexity in facial skeletal anatomy cause multiple medical and surgical challenges to an operating surgeon, demanding elaborate soft and hard tissue reconstructions. Here we present the successful management of a patient shot by a low-velocity short-range pistol with basic life support measures, wound management, reconstruction, and rehabilitation.
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Affiliation(s)
- K V Arunkumar
- Department of Dentistry, ONGC (Oil & Natural Gas Corporation), Dehradun, Utharakhand, India
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Brown Baer PR, Wenke JC, Thomas SJ, Hale CRG. Investigation of severe craniomaxillofacial battle injuries sustained by u.s. Service members: a case series. Craniomaxillofac Trauma Reconstr 2012; 5:243-52. [PMID: 24294409 DOI: 10.1055/s-0032-1329542] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2012] [Accepted: 03/01/2012] [Indexed: 10/27/2022] Open
Abstract
This case series describes craniomaxillofacial battle injuries, currently available surgical techniques, and the compromised outcomes of four service members who sustained severe craniomaxillofacial battle injuries in Iraq or Afghanistan. Demographic information, diagnostic evaluation, surgical procedures, and outcomes were collected and detailed with a follow-up of over 2 years. Reconstructive efforts with advanced, multidisciplinary, and multiple revision procedures were indicated; the full scope of conventional surgical options and resources were utilized. Patients experienced surgical complications, including postoperative wound dehiscence, infection, flap failure, inadequate mandibular healing, and failure of fixation. These complications required multiple revisions and salvage interventions. In addition, facial burns complicated reconstructive efforts by delaying treatment, decreasing surgical options, and increasing procedural numbers. All patients, despite multiple surgeries, continue to have functional and aesthetic deficits as a result of their injuries. Currently, no conventional treatments are available to satisfactorily reconstruct the face severely ravaged by explosive devices to an acceptable level, much less to natural form and function.
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Affiliation(s)
- Pamela R Brown Baer
- Department of Craniomaxillofacial Regenerative Medicine, Dental and Trauma Research Detachment
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Johnson J, Markiewicz M, Bell R, Potter B, Dierks E. Gun orientation in self-inflicted craniomaxillofacial gunshot wounds: risk factors associated with fatality. Int J Oral Maxillofac Surg 2012; 41:895-901. [DOI: 10.1016/j.ijom.2012.05.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2011] [Accepted: 05/14/2012] [Indexed: 11/16/2022]
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Dumas JE, BrownBaer PB, Prieto EM, Guda T, Hale RG, Wenke JC, Guelcher SA. Injectable reactive biocomposites for bone healing in critical-size rabbit calvarial defects. Biomed Mater 2012; 7:024112. [DOI: 10.1088/1748-6041/7/2/024112] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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17
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Ocular reconstruction after zygomatic complex fracture with retention of a foreign body. J Craniofac Surg 2011; 22:1394-7. [PMID: 21772171 DOI: 10.1097/scs.0b013e31821cc2e2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Facial injuries with the retention of foreign bodies inside the tissues, both in soft and hard ones, can cause major functional and aesthetic damage. Among the different etiological agents, cutting tools, fragments of a firearm, the splinter of wood, steel, or iron, launched by misuse, or even caused by defects in equipment, are the main cause of these injuries. The aim of this study was to discuss the peculiarity of the multidisciplinary approach in caring of a 33-year-old man, victim of an accident at work, by the rupture of an emery disc and consequent penetration of the fragments in violation of the tissues in the orbital and zygomatic region of the left side, with perforation of the eyeball and orbital-zygomatic fracture. Urgent treatment consisted of debridement of wounds, bleeding control, removal of foreign bodies, fracture reduction with rigid internal fixation, and suture, performed by the oral and maxillofacial surgical team. Reconstruction of orbital tissues by the ophthalmology team consisted of suture of the injuries. About 1 month after the trauma, phthisis bulbi was noted, and the patient underwent a new procedure under general anesthesia for eye evisceration and installation of an alloplastic prosthesis associated with the homogenous sclera. Facial harmony was restored, especially in aesthetics and function of the zygomatic-orbital complex.
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Motamedi MHK. Management of firearm injuries to the facial skeleton: Outcomes from early primary intervention. J Emerg Trauma Shock 2011; 4:212-6. [PMID: 21769208 PMCID: PMC3132361 DOI: 10.4103/0974-2700.82208] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 09/24/2010] [Indexed: 12/22/2022] Open
Abstract
Aim: Treatment of maxillofacial firearm injuries is still controversial with regard to timing of management. We postulate that not all maxillofacial firearm injuries need be delayed and that many may be treated early. To this end, a 19-year retrospective study was undertaken seeking to evaluate patients treated for firearm injuries to the facial skeleton at our center. The criteria which dictated when to operate are presented as are the results, benefits, and outcomes of the patients treated acutely. Patients and Methods: From 1991 to 2010, 51 patients with maxillofacial firearm injuries were treated; 30/51 patients received early primary repair and simultaneous open reduction for facial fractures. These underwent primary debridement and arch bar placement followed by open reduction of fractures (with or without osteosynthesis) and primary wound closure. Patient age ranged from 8 to 50 years, with a mean age of 24.4±7.8 years. Primary early intervention was done when there was no gross infection, no bone comminution or extensive soft tissue avulsion (precluding wound coverage), and when general health, concomitant injuries requiring more urgent attention or those requiring major grafts did not preclude this. Primary intervention included extensive oral and extraoral irrigation (dilute hydrogen peroxide + povidone iodide), debridement of the facial wound, removal of floating fragments (teeth particles, debris, and shell fragments) precluding viable bone within the wound, access to the bone, finding the scattered bone segments and putting them back into place to restore bone continuity. Projectiles beyond the wound were not searched for. Tooth roots within the alveolus were not extracted at this stage. In addition to arch bars, titanium miniplates or wire osteosynthesis was done when necessary. All wounds were closed primarily (using local advancement flaps when necessary) and all patients were placed on antibiotics (cephalosporin + aminoglycoside or ciprofloxacin) upon admission. Results: Of 51 patients, 30 were treated acutely and 21 warranted delayed intervention. In the acute-treated group, 6/30 patients had minor complications such as scarring and wound discharge. Early intervention for firearm wounds to the face was effective for facial firearm injuries in selected cases. This resulted in restoration of occlusion and continuity of the jaw, fixation of luxated teeth, early return of function, prevention of segment displacement and tissue contracture, less scarring, and decreased the need for major bone graft reconstruction later on. Those treated secondarily were only debrided and had arch bars placed. Definitive treatment of hard and soft tissue management was rendered in another subsequent operation. Bone reduction was more difficult because of scarring, and displacement of remaining segments. No significant differences were noted in terms of infection or other major complications. Conclusions: Firearm wounds were associated with a high incidence of maxillofacial injuries requiring surgical intervention. Many may be treated definitively and acutely with procedures designed to repair both bone and soft tissue injuries simultaneously aiming to restore bony continuity, esthetics and function using the tissues at hand (especially in the mandible). Early treatment is advocated because the course of healing is not disrupted with another subsequent operation (in the same wound) and because it may decrease hospital stay without increasing patient morbidity in selected patients. Patients with residual defects can be treated later as out-patients.
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Tabariai E, Sandhu S, Alexander G, Townsend R, Julian R, Bell G, Chien A, Soares B, Sikavi C. Management of facial penetrating injury--a case report. J Oral Maxillofac Surg 2010; 68:182-7. [PMID: 20006175 DOI: 10.1016/j.joms.2009.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 08/28/2009] [Accepted: 09/02/2009] [Indexed: 11/29/2022]
Affiliation(s)
- Eli Tabariai
- Department of Oral and Maxillofacial Surgery, University Medical Center-Fresno Community Medical Centers, Fresno, CA 93702, USA.
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