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Published on: September 21, 2017
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Maxillofacial ballistic injuries: A 13-year single-institution experience
Sebastian Leander Stein1, Boris Kos2, Emil Dediol3
1School of Medicine, University of Zagreb, 10000 Zagreb, Croatia.
Journal of Stomatology, Oral and Maxillofacial Surgery
|December 25, 2025
Summary
Early, definitive reconstruction of maxillofacial ballistic and pyrotechnic injuries leads to fewer complications and better long-term outcomes. This approach, utilizing free flaps and local flaps, improves both function and aesthetics for patients.
Area of Science:
- Oral and Maxillofacial Surgery
- Plastic and Reconstructive Surgery
- Trauma Surgery
Background:
- Maxillofacial ballistic and pyrotechnic injuries present significant reconstructive challenges due to extensive tissue loss and infection risks.
- While early reconstruction with vascularized tissue is favored, optimal timing and outcomes remain debated.
- These injuries demand a balance between functional restoration and aesthetic results.
Purpose of the Study:
- To evaluate the outcomes of early versus delayed definitive reconstruction for ballistic and pyrotechnic maxillofacial injuries.
- To identify factors influencing functional and aesthetic results in complex facial trauma reconstruction.
- To compare complication rates between early and delayed reconstructive approaches.
Main Methods:
- Retrospective analysis of 17 patients with ballistic or pyrotechnic facial injuries treated between 2010 and 2023.
- Data collection included injury mechanism, affected regions, reconstructive methods (free flaps, pectoralis major flaps), and complications.
- Functional outcomes assessed using the Head and Neck Functional Integrity Scale (HNC-FIT), and aesthetic outcomes via Visual Analog Scale (VAS).
Main Results:
- All patients had combined bone and soft tissue injuries, with 71% resulting from suicide attempts.
- Early major reconstruction correlated with fewer and later complications compared to delayed reconstruction.
- Patients with lateral defects reported better functional (HNC-FIT) and aesthetic (VAS) outcomes than those with central defects.
Conclusions:
- Early, definitive reconstruction of maxillofacial ballistic and pyrotechnic injuries is associated with superior long-term functional and aesthetic outcomes and reduced complications.
- Bony free flaps are effective for bone defects, while local flaps are crucial for complex central facial regions.
- Tailored combinations of reconstructive techniques are often necessary for complex facial defects.
