[Primary management of 2 unusual facial injuries]

In the first patient a spinning saw-blade cut through the soft tissues and bony structures of the face in a paramedian, vertical section; in another patient a dum-dum bullet fired in suicidal intention from submentally destroyed the frontal half of the mandible and maxilla, the nose and the medial part of both orbits. The facial soft tissues, however, suffered only minor injuries. In the first patient the immediate treatment included inspection of the frontal sinus, preserving all loose bone fragments, and immediate reconstruction of the medial orbital frame employing bonewires, identification of the lacrimal ducts, reapproximation and stabilisation of these ducts with very flexible silicone threads, soft-tissue closure employing a running z-plasty, interdigitating the z-shaped wound edges caused by the saw. In the second patient stability of the remaining mandibular portions was achieved by mandibular reconstruction plates to which all remaining mandibular bone fragments were attached with bone screws or wires. The stabilized mandible allowed suspension of the tongue.