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

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.

Keywords

gunshot maxillofacial damage control surgery salvage surgery

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References

Kaufman

Cole

Hollier

Jr . Facial Gunshot wounds: trends in management. Craniomaxillofac Trauma Reconstr. 2009;2(2):85–90.

Doctor

Farwell

. Gunshot wounds to the head and neck. Curr Opin Otolaryngol Head Neck Surg. 2007;15(4):213–218.

Stefanopoulos

Filippakis

Soupiou

Pazarakiotis

. Wound ballistics of firearm-related injuries—Part 1: Missile characteristics and mechanism of soft tissue wounding. Int J Oral Maxillofac Surg. 2014;43(12):1445–1458.

Powers

Robertson

. Ten common myths of ballistic injuries. Oral Maxillofacial. Surg Clin North Am. 2005;17(3):251–259.

Stefanopoulos

Soupiou

Pazarakiotis

Filippakis

. Wound ballistics of firearm-related injuries—Part 2: Missile characteristics and mechanism of soft tissue wounding. Int J Oral Maxillofac Surg. 2015;44(1):67–68.

Motamedi

MHK

. Primary management of maxillofacial hard and soft tissue gunshot and shrapnel injuries. J Oral Maxillofac Surg. 2003;61(12):1390–1398.

Motamedi

. Primary treatment of penetrating injuries to the face. J Oral Maxillofac Surg. 2007;65(6):1215–1258.

Lamb

MacGoey

Navarro

Brooks

. Damage control surgery in the era of damage control resuscitation. Br J Anaesth 2014;113(2):242–249.

Duchesne

McSwain

Jr Cotton

, et al. Damage control resuscitation: the newface of damage control. J Trauma 2010;69(4):976–990.

10.

Rotondo

Zonies

. The damage control sequence and underlying logic. Surg Clin North Am. 1997;77(4):(761–777).

11.

Krausz

Picetti

. Maxillofacial and neck trauma: a damage control approach. World J Emerg Surg. 2015;10:31, DOI 10.1186/s13017-015-0022-9.

12.

Firoozmand

Velmahos

. Extending damage-control principles to the neck. J Trauma. 2000;48(3):541–543.

13.

Rezende-Neto

Marques

Guedes

Teixeira

. Damage control principles applied to penetrating neck and mandibular injury. J Trauma. 2008;64(4):1142–1143.

14.

Monson

Saletta

Freeark

. Carotid vertebral trauma. J Trauma. 1969;9(12):987–999.

15.

Hollier

Grantcharova

Kattash

. Facial gunshot wounds: a 4-year experience. J Oral Maxillofac Surg. 2001;59(3):277–282.

16.

Arasa

Altas

Yılmaza

, et al. Being a neighbor to Syria: a retrospective analysis of patients brought to our clinic for cranial gunshot wounds in the Syrian civil war. Clin Neurol Neurosurg. 2014;125(2014):222–228.

17.

Mabry

Holcomb

Baker

, et al. United States Army Rangers in Somalia: an analysis of combat casualties on an urban battlefield. J Trauma. 2000;49(3):515–529.

18.

Lakstein

Blumenfeld

. Israeli army casualties in the second Palestinian uprising. Mil Med. 2005;170(5):427–430.

19.

Al-Anee

Al-Quisi

Al-Jumaily

. Mandibular war injuries caused by bullets and shell fragments: a comparative study. Oral Maxillofac Surg. 2018;22(3):303–307.

20.

Lin

Cheng

. Mandibular fracture patterns at a medical center in Central Taiwan. A 3-year epidemiological review. Medicine 2017;96(51):1–4.

21.

Lew

Walker

Wenke

Blackbourne

Hale

. Characterization of craniomaxillofacial battle injuries sustained by United States service members in the current conflicts of Iraq and Afghanistan. J Oral Maxillofac Surg. 2010;68(1):3–7.

22.

Breeze

Gibbons

Shieff

, et al. Combat-related craniofacial and cervical injuries: a 5 year review from the British military. J Trauma. 2011;71(1):108–113.

23.

Abramowicz

Allareddy

Rampa

, et al. Facial fractures in patients with firearm injuries: profile and outcomes. J Oral Maxillofac Surg. 2017;75(10):2170–2176.

24.

Keller

Han

Galarneau

Gaball

. Characteristics of maxillofacial injuries and safety of in-theater facial fracture repair in severe combat trauma. Mil Med. 2015;180(3):315–320.

25.

Lanigan

Lindsey

Maturo

Brennan

Laury

. The Joint Facial and Invasive Neck Trauma (J-FAINT) Project, Iraq and Afghanistan: 2011-2016. Otolaryngol Head Neck Surg. 2017;157(4):602–607.

26.

Mclean

Moore

Yellin

. Gunshot wounds to the face—acute management. Facial Plast Surg. 2005;21(3):191–198.

27.

Gruss

Antonyshyn

Phillips

. Early definitive bone and soft-tissue reconstruction of major gunshot wounds of the face. Plast Reconstr Surg. 1991;87(30):436–450.

28.

Vayvada

Menderes

Yilmaz

Mola

Kzlkaya

Atabey

. Management of close range, high energy shotgun and rifle wounds to the face. J Craniofac Surg. 2005;16(5):794–804.

29.

Ueeck

. Penetrating injuries to the face: Delayed versus primary treatment-considerations for delayed treatment. J Oral Maxillofac Surg. 2007;65(6):1209–1214.

30.

Gibbons

Breeze

. The face of war: the initial management of modern battlefield ballistic facial injuries. J Mil Veterans Health. 2011;19(2):15–18.

31.

Gibbons

Mackenzie

. Lessons learned in oral and maxillofacial surgery from British military deployments in Afghanistan. J R Army Med Corps. 2010;156(2):113–622.

32.

Baig

. Current trends in the management of maxillofacial trauma. Ann R Australas Coll Dent Surg. 2002;16:123–127.

33.

Thach

Johnson

Carrol

, et al. Severe eye injuries in the war in Iraq, 2003-2005. Ophthalmology. 2008;115(2):377–382.

34.

Cockerham

Rice

Hewes

, et al. Closed-eye ocular injuries in the Iraq and Afghanistan wars. N Engl J Med. 2011;364(22):2172–2173.

35.

Breeze

Horsfall

Hepper

Clasper

. Face, neck, and eye protection: adapting body armour to counter the changing patterns of injuries on the battle field. Br J Oral Maxillofac Surg. 2011;49(8):602–606.