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Naija S, Yacoub A, Barhoumi M, Akkeri K, Chebbi G. [Ballistic trauma of the face: A new scourge in Tunisia]. ANN CHIR PLAST ESTH 2021; 66:210-216. [PMID: 33838955 DOI: 10.1016/j.anplas.2021.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/08/2021] [Accepted: 03/10/2021] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- S Naija
- Services d'oto-rhino-laryngologie, de chirurgie maxillo-faciale et d'ophtalmologie de l'hôpital militaire principal d'instruction de Tunis, Tunis, Tunisie
| | - A Yacoub
- Services d'oto-rhino-laryngologie, de chirurgie maxillo-faciale et d'ophtalmologie de l'hôpital militaire principal d'instruction de Tunis, Tunis, Tunisie.
| | - M Barhoumi
- Services d'oto-rhino-laryngologie, de chirurgie maxillo-faciale et d'ophtalmologie de l'hôpital militaire principal d'instruction de Tunis, Tunis, Tunisie
| | - K Akkeri
- Services d'oto-rhino-laryngologie, de chirurgie maxillo-faciale et d'ophtalmologie de l'hôpital militaire principal d'instruction de Tunis, Tunis, Tunisie
| | - G Chebbi
- Services d'oto-rhino-laryngologie, de chirurgie maxillo-faciale et d'ophtalmologie de l'hôpital militaire principal d'instruction de Tunis, Tunis, Tunisie
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Maia ABP, Assis SG, Ribeiro FML, Pinto LW. The marks of gunshot wounds to the face. Braz J Otorhinolaryngol 2019; 87:145-151. [PMID: 31540871 PMCID: PMC9422606 DOI: 10.1016/j.bjorl.2019.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/22/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction This article deals with the occurrence of health problems due to gunshot wounds to the face among military police officers, in the metropolitan region of Rio de Janeiro, who were submitted to surgery at the Oral and Maxillofacial Surgery and Traumatology Clinic of Hospital Central da Polícia Militar. Objective To identify the profile of patients submitted to surgery as a result of gunshot wounds, the anatomical distribution of maxillofacial fractures, the identified sequelae and complications, the health specialties involved in the rehabilitation of these patients, and to discuss the social, emotional and work performance-related effects of work among these subjects. Methods A retrospective epidemiological study was carried out based on secondary data from military police officers who were submitted to surgery at Hospital Central da Polícia Militar due to gunshot wounds from June 2003 to December 2017. Results During the study period, 778 surgeries were performed in the operating room by the Oral and Maxillofacial Surgery and Traumatology service at Hospital Central da Polícia Militar, 186 of which were due to gunshot wounds (23.9%). All patients were males and the mean age 34.7 years. Bone segment loss was the most common sequela. Facial esthetic impairment and reports of insomnia were the most often identified late consequences of impact on health and social life. Regarding the occupational impacts of the sustained injury, the mean time away from work due to medical leave for the treatment of maxillofacial injuries was 11.7 months. Conclusion The treatment of gunshot wounds patients with facial injuries requires multiple surgical interventions and their rehabilitation requires the involvement of different health specialties. Further studies are needed to qualitatively analyze the impact of this type of facial trauma on the patients' lives and their social consequences.
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Affiliation(s)
- Adriane Batista Pires Maia
- Colégio Brasileiro de Cirurgia e Traumatologia Bucomaxilofacial, São Paulo, SP, Brazil; Escola Nacional de Saúde Pública da Fundação Oswaldo Cruz (ENSP/FIOCRUZ), Departamento Latino-Americano de Estudos de Violência Sérgio Carelli, Rio de Janeiro, RJ, Brazil; Hospital Central da Polícia Militar do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
| | - Simone Gonçalves Assis
- Escola Nacional de Saúde Pública da Fundação Oswaldo Cruz (ENSP/FIOCRUZ), Departamento Latino-Americano de Estudos de Violência Sérgio Carelli, Rio de Janeiro, RJ, Brazil
| | - Fernanda Mendes Lages Ribeiro
- Escola Nacional de Saúde Pública da Fundação Oswaldo Cruz (ENSP/FIOCRUZ), Departamento Latino-Americano de Estudos de Violência Sérgio Carelli, Rio de Janeiro, RJ, Brazil
| | - Liana Wernersbach Pinto
- Escola Nacional de Saúde Pública da Fundação Oswaldo Cruz (ENSP/FIOCRUZ), Departamento Latino-Americano de Estudos de Violência Sérgio Carelli, Rio de Janeiro, RJ, Brazil
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Costa ST, Freire AR, Matoso RI, Daruge Júnior E, Rossi AC, Prado FB. Computational Approach to Identify Different Injuries by Firearms. J Forensic Sci 2017; 62:361-368. [PMID: 28247449 DOI: 10.1111/1556-4029.13387] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 06/08/2016] [Accepted: 06/25/2016] [Indexed: 11/30/2022]
Abstract
Complications arise in the analysis of gunshot wounds to the maxillofacial region, when neither the projectile nor the gun is found at the crime scene. We simulated 5- and 15-cm firing distances at a human mandible to investigate the external morphology of entrance wounds based on fire range. The ammunition models, .40-caliber S&W, .380-caliber, and 9 × 19-mm Luger, were constructed with free-form NURBS surfaces. In a dynamic simulation, projectiles were fired against mandibular body 3D model at 5 and 15 cm. All entrance wounds presented oval aspect. Maximum diameter and von Mises stress values were 16.5 mm and 50.8 MPa, both for .40-caliber S&W fired at 5 cm. The maximum energy loss was 138.4 J for .40 S&W fired at 15 cm. In conclusion, the mandible was most affected by .40-caliber S&W and morphological differences were observable in holes caused by different incoming projectile calibers fired at different distances.
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Affiliation(s)
- Sarah Teixeira Costa
- Department of Social Dentistry, Forensic Dentistry Division, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Alexandre Rodrigues Freire
- Department of Morphology, Anatomy Division, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Rodrigo Ivo Matoso
- Department of Morphology, Anatomy Division, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Eduardo Daruge Júnior
- Department of Social Dentistry, Forensic Dentistry Division, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Ana Cláudia Rossi
- Department of Morphology, Anatomy Division, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
| | - Felippe Bevilacqua Prado
- Department of Morphology, Anatomy Division, Piracicaba Dental School, University of Campinas, Piracicaba, São Paulo, Brazil
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Gunshot-caused Facial Injury Combined with Lower Cervical Spine Injury: A Case Report. W INDIAN MED J 2014; 63:378-81. [PMID: 25429487 DOI: 10.7727/wimj.2013.260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/27/2013] [Indexed: 11/18/2022]
Abstract
A 32-year old male patient was wounded by a pistol. As shown in computed tomography (CT) scanning images, there was comminuted fracture of the left mandible and the bullet was found in the left side behind the sixth cervical vertebra. After the patient was hospitalized, the debridement was done in the emergency room and the operation of open reduction and internal fixation for comminuted fracture of left mandible was performed successfully. Eighteen days later, the patient was taken to surgery for anterior cervical decompression and fusion with autogenous iliac bone grafting for the sixth cervical vertebra. Postoperative follow-up of the patient over two years indicated that the left biceps muscle strength was recovered to level 4. Gunshot wound to the face associated with injury of the low cervical spine has the possibility of survival. It is safe to treat facial wounds early in the patient's treatment course, even if the bullet remains in the cervical vertebral body and there is neurological function damage.
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Ongom PA, Kijjambu SC, Jombwe J. Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report. J Med Case Rep 2014; 8:29. [PMID: 24467784 PMCID: PMC3917526 DOI: 10.1186/1752-1947-8-29] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2013] [Accepted: 11/26/2013] [Indexed: 11/14/2022] Open
Abstract
Introduction Gunshot injuries of the head and neck from the AK-47 rifle (a common assault rifle, submachine gun type) are a significant contributor to morbidity and mortality among civilians in Sub-Saharan Africa. They may cause significant damage to the closely arranged structures in this region, and the bullet’s trajectory can be very difficult to determine. We present an unusual case of gunshot injury with an atypical bullet entry wound, profound injury to the face, lodgment in the right carotid sheath, and 'wandering’; a first of its kind in East Africa. Case presentation A 27-year-old African-Ugandan woman of Nilotic ethnicity was referred to the Accident and Emergency Department of a tertiary hospital in Uganda, having sustained complex injuries due to an inadvertent AK-47 rifle gunshot injury. The gunshot injury was to the right side of her face with a large ragged entry wound and no exit wound. Prior basic wound care and radiological imaging showed a comminuted fracture of her mandible with lodgment of the bullet in her neck, anterior to her sixth and seventh cervical vertebrae. Standard debridement of her wound was done. A computed tomography scan showed an apparent cephalad shift ('wandering’) of the bullet, leaving it lying partially anterior to her fifth cervical vertebra as well as within her carotid sheath. Other injuries were to her facial and trigeminal nerves, and her middle ear. The 'wandering’ bullet was successfully removed surgically. It had caused no damage to any part of her neck structure. Conclusion AK-47 rifle bullet injuries may present with uncharacteristically large entry wounds and cause complex structural injuries at the area of impact. The consequent trajectory is difficult to predict making regional examination and radiological investigations essential in management. Bullets may be retained, leaving no exit wound. Securing the airway, controlling hemorrhage and identifying other injuries are the first vital steps. This case illustrates all these interventions and the important decision to extract the entrapped bullet from the patient’s neck because it had started to 'wander’ and could have caused grave injury over time with further migration. Maxillofacial, plastic, trauma, general and military surgeons, otorhinolaryngologists and emergency physicians can gain from this experience because it calls for a multidisciplinary team approach.
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Affiliation(s)
- Peter A Ongom
- Department of Surgery, School of Medicine, Makerere College of Health Sciences, Makerere University, P O Box 7072 Kampala, Uganda.
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Prevention of infections associated with combat-related eye, maxillofacial, and neck injuries. ACTA ACUST UNITED AC 2011; 71:S264-9. [PMID: 21814092 DOI: 10.1097/ta.0b013e318227ad9a] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The percentage of combat wounds involving the eyes, maxillofacial, and neck regions reported in the literature is increasing, representing 36% of all combat-related injuries at the start of the Iraq War. Recent meta-analysis of 21st century eye, maxillofacial, and neck injuries described combat injury incidences of 8% to 20% for the face, 2% to 11% for the neck, and 0.5% to 13% for the eye and periocular structures. This article reviews recent data from military and civilian studies to support evidence-based recommendations for the prevention of infections associated with combat-related eye, maxillofacial, and neck injuries. The major emphasis of this review is on recent developments in surgical practice as new antimicrobial studies were not performed. Further studies of bacterial infection epidemiology and postinjury antimicrobial use in combat-related injuries to the eyes, maxillofacial, and neck region are needed to improve evidence-based medicine recommendations. This evidence-based medicine review was produced to support the Guidelines for the Prevention of Infections associated with Combat-related Injuries: 2011 Update contained in this supplement of Journal of Trauma.
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Guruprasad Y, Giraddi G. Unusual case of gunshot injury to the face. J Clin Imaging Sci 2011; 1:3. [PMID: 21915384 PMCID: PMC3169893 DOI: 10.4103/2156-7514.73501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Accepted: 10/05/2010] [Indexed: 11/20/2022] Open
Abstract
An unusual case of facial gunshot injury with the missile lodged in the cervical spine region, but without any neurological impairment, is reported. The extent of tissue damage and missile track termination in a male patient who sustained gunshot trauma to the face was assessed by plain radiography and by computed tomography scans. The patient was treated conservatively and observed for clinical manifestations of neurological deficit for one year. We present a case of gunshot injury to the face with the missile lodged in the cervical spine region and atypical absence of clinical manifestation that may occur even when a bullet remains in the vicinity of the cervical spine.
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Affiliation(s)
- Yadavalli Guruprasad
- Department of Oral and Maxillofacial Surgery, AME'S Dental College Hospital and Research Centre, Raichur, India
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Sansare K, Khanna V, Karjodkar F. The role of maxillofacial radiologists in gunshot injuries: a hypothesized missile trajectory in two case reports. Dentomaxillofac Radiol 2010; 40:53-9. [PMID: 21159916 DOI: 10.1259/dmfr/72527764] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Gunshot injuries are an emerging form of trauma that oral radiologists increasingly have to deal with. There are two main types of gunshot injuries: high-velocity and low-velocity bullet injuries. The outcome of high-velocity gunshot injury is usually fatal; however, a non-fatal low-velocity injury to the maxillofacial region is more likely to be encountered by the oral and maxillofacial radiologist. It is therefore important to up-to-date knowledge of ballistic science and its implications in the field of maxillofacial radiology. The ability of oral and maxillofacial radiologists to predict the missile trajectory will aid the assessment and localization of the damage caused by the bullet and its splinters. Predicting the missile trajectory may also be of help to law enforcement agencies and forensic scientists in determining the type of firearm used and direction of fire. This article, which examines two cases, attempts to highlight to the oral radiologist this emerging form of trauma and its implications.
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Affiliation(s)
- K Sansare
- Oral Medicine and Radiology, Nair Hospital Dental College, Mumbai, India.
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Prevention and Management of Infections Associated With Combat-Related Head and Neck Injuries. ACTA ACUST UNITED AC 2008; 64:S265-76. [DOI: 10.1097/ta.0b013e318163d2a6] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bumbasirević M, Lesić A, Bumbasirević V, Rakocević Z, Djurić M. Gunshot injury to the face with a missile lodged in the upper cervical spine without neurological deficit. Dentomaxillofac Radiol 2006; 35:38-42. [PMID: 16421263 DOI: 10.1259/dmfr/29317043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
An unusual case of facial gunshot injury with the missile lodged in the cervical spinal canal, but without any neurological impairment is reported. The extent of tissue damage and missile track termination in a male patient who sustained gunshot trauma to the face was assessed by plain radiography and by CT scans. The patient was treated conservatively and observed for clinical manifestations of neurological deficit for 3 weeks. CT of the head and neck performed 13 years after injury with the three-dimensional (3D) reconstruction of skeletal elements revealed healed fractures of the right nasal bone, the labyrinth of the right ethmoid bone, and position of the missile on the medial aspect of the right lateral mass of the atlas. There was no migration of the missile during this period. This case report of gunshot wound to the face associated with injury of the cervical spine indicated possibility of survival and atypical absence of clinical manifestation that may occur even when a bullet remains in the spinal canal.
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Affiliation(s)
- M Bumbasirević
- Institute for Orthopaedic Surgery and Traumatology, University Clinical Centre, Belgrade, Serbia
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