Close range blasts toward the maxillofacial region in attempted suicide

In Sweden, suicides and attempted suicides with firearms are rare. This retrospective study is based on our experience with 12 consecutive cases of attempted suicide not resulting in death but in facial injuries. The extent of soft and hard tissue injuries is presented for each case. The maxilla was the bone most often fractured. Six patients sustained mandibular fractures, three with major bone defects. Depression was by far the most common emotional state immediately preceding the suicide attempt. At least four patients were under the influence of alcohol at the time of the injury. Initial treatment included sharp, conservative debridement and internal or external fixation of jaws. Bone grafting, local or distant flaps were postponed until all devitalized tissue was recognized. We conclude that these self-inflicted injuries with an initially grotesque appearance respond well to conservative debridement and early reconstruction, leading to satisfactory functional aesthetic, social and psychiatric rehabilitation.