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Fracture Patterns in Craniofacial Gunshot Wounds: A Seven-Year Experience.
Gabriela G Cruz1, Sameer H Siddiqui2, David Z Allen2
1John P. and Katherine G. McGovern Medical School, The University of Texas Health Science Center in Houston, Houston, TX 77030, USA; brady-anderson@uiowa.edu (B.J.A.); mark.knackstedt@lsuhs.edu (M.K.).
Craniomaxillofacial Trauma & Reconstruction
|April 25, 2025
Summary
Facial fractures from gunshot wounds (GSWs) often involve the maxilla, orbit, and mandible. Predictors for surgical repair include tracheostomy and transfascial injuries, while timing to reconstructive surgery impacts hospital length of stay (LOS).
Area of Science:
- Trauma Surgery
- Facial Reconstructive Surgery
- Ballistics Trauma
Background:
- Gunshot wounds (GSWs) to the head and face present complex challenges in trauma care.
- Facial fractures resulting from GSWs require specialized management strategies.
Purpose of the Study:
- To characterize facial fracture patterns in patients with head, neck, or facial GSWs.
- To identify predictors of surgical repair and hospital length of stay (LOS) for these injuries.
Main Methods:
- Retrospective cohort chart review of patients admitted with head, neck, or facial GSWs (January 2013 - March 2020).
- Univariate and multivariate analyses were performed to determine associations with surgical repair and LOS.
Main Results:
- Of 578 patients, 204 sustained facial fractures, most commonly involving the maxilla (62%), orbit (55%), and mandible (51%).
- Mandible fractures had the highest operative rates (76%). Predictors for surgical repair included tracheostomy, transfascial injury, and longer initial hospital stay.
- Earlier facial plastic reconstructive surgery (FPRS) (<5 days) and gastrostomy tube placement predicted shorter hospital LOS.
Conclusions:
- Management of GSW-related facial fractures necessitates consideration of functional and aesthetic outcomes alongside other injuries.
- Factors like ICU admission, GSW trajectory, tracheostomy, and fracture location influence operative repair rates.
- Timing of FPRS is a key predictor of inpatient LOS for patients undergoing reconstructive surgery.
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