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The new face of war: Craniofacial injuries from Operation Inherent Resolve
Daniel C Neubauer1, Macario Camacho, Eamon B O'Reilly
1From the Department of Surgery (D.C.N.), Naval Medical Center San Diego, and Trauma Service, Scripps Mercy Hospital, San Diego, California; Department of Surgery (M.C.), Tripler Army Medical Center, Honolulu, Hawaii; Department of Surgery (E.B.O.), Naval Medical Center San Diego, San Diego, California; Department of Surgery (M.B.), Madigan Army Medical Center, Joint Base Lewis-McChord, Washington; Joint Trauma System (J.M.G.), San Antonio, Texas; and Department of Surgery (M.J.M.), University of Southern California, Los Angeles, California.
Complex craniofacial trauma (CFT) is rising due to modern warfare. A specialized head and neck team improved management and outcomes for both US and local national patients in Iraq and Syria.
Area of Science:
- Military medicine
- Surgical oncology
- Trauma surgery
Background:
- Complex craniofacial trauma (CFT) is a growing concern in Middle Eastern conflicts.
- Improvements in body armor and IEDs contribute to increased CFT incidence, comprising up to 40% of casualties.
- This study presents data from Operation Inherent Resolve in Iraq and Syria.
Purpose of the Study:
- To analyze the incidence and patterns of CFT in recent conflicts.
- To evaluate the impact of a deployed head and neck surgical team on patient management.
- To assess outcomes for CFT patients treated in deployed military facilities.
Main Methods:
- A cross-sectional study of CFT patients treated at role 1, 2, and 3 facilities over one year.
- Data collection included injury type, mechanism, triage, care levels, and procedures.
- A specialized head and neck surgical augmentation team was deployed to the role 3 facility.
Main Results:
- Ninety-six patients sustained CFT, with soft tissue, cranial, and orbital/facial injuries being most common.
- Improvised explosive devices (IEDs) correlated with cranial/truncal injuries; GSWs and blunt trauma with orbital/facial/neck injuries.
- 45% required surgery, 6% mortality (83% due to brain injury); 70% of patients were local nationals.
Conclusions:
- Deployed surgeons encounter increasing CFT, irrespective of specialty.
- A dedicated, centrally located head and neck team significantly enhances forward management capabilities for CFT.
- Excellent outcomes were achieved for both US military personnel and local national patients.
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