Complex craniomaxillofacial gunshot wounds A step-by-step multidisciplinary approach

Area of Science:

• Trauma Surgery
• Neurosurgery
• Maxillofacial Surgery

Background:

• Gunshot injuries to the viscerocranium are uncommon and present significant surgical challenges.
• These injuries often involve extensive soft tissue, bone, and cerebral defects, demanding specialized care.
• This report focuses on a rare case of a suicidal gunshot wound to the viscerocranium.

Observation:

• A 42-year-old female sustained a gunshot wound with inlet in the submental region and outlet in the left temporal skull.
• Initial management included ICP monitoring, embolization of the internal maxillary artery, tracheostomy, and maxillo-facial fracture reduction.
• Subsequent ICP monitoring and CT scans revealed intracranial hemorrhage, necessitating a bifrontal decompressive craniectomy.

Findings:

• The patient underwent staged surgical interventions, including emergency procedures and delayed craniomaxillofacial reconstruction.
• Post-operative recovery involved intensive care, rehabilitation, and eventual reconstruction, with significant neurological and functional improvements.
• The patient achieved a Glasgow Coma Scale score of 15 and Karnofsky Performance Status of 100% at follow-up.

Implications:

• A coordinated, multidisciplinary approach involving neurosurgeons and maxillofacial surgeons is essential for optimal outcomes in cranial gunshot injuries.
• Early and comprehensive surgical management, including debridement, hemorrhage control, and reconstruction, is crucial.
• Effective management of extensive damage in cranial gunshot injuries can significantly improve patient survival and functional recovery.