Extensive Craniofacial Trauma Caused by an Intraoral Pyrotechnic Explosion in a Patient with Paranoid Schizophrenia

Background: Intraoral explosions of pyrotechnic devices are exceptionally rare and combine blast overpressure, penetrating fragments, thermal injury, and extensive wound contamination. The immediate threats include airway obstruction, hemorrhage, loss of facial buttresses, and destruction of the occlusal unit. This report describes the acute multidisciplinary management of a self-inflicted intraoral pyrotechnic explosion in a male patient during an exacerbation of paranoid schizophrenia. Case presentation: The explosion caused bilateral comminution of the midface, fractures of the mandibular body/symphysis and right condylar process, a right orbital floor defect, extensive injury to the palate and tongue, bilateral wounds of the oral commissures and cheeks, and retention of metallic and pyrotechnic debris. Concomitant polytrauma included spinal, pelvic, rib, and pulmonary injuries. Massive edema and oral bleeding necessitated emergency tracheostomy. The otolaryngology team reconstructed the tongue and floor of the mouth, after which the maxillofacial team performed prolonged skeletal reconstruction through combined external and intraoral approaches. The midface was stabilized with 13 titanium miniplates, the mandibular body with a 2.0-mm fixation system, and the right orbital floor with a polydioxanone sheet. Nonviable teeth were removed. Because of severe edema and the high risk of iatrogenic facial nerve injury, the right condylar fracture was managed conservatively, and the patient's habitual occlusion could not be fully restored during the acute operation. Approximately four months after the injury, computed tomography (CT) demonstrated partial osseous bridging and stable residual right zygomatic displacement without signs of an active inflammatory process. Conclusions: In devastating intraoral blast injury, airway security, preservation of viable soft tissue, control of contamination, and restoration of a stable skeletal framework take priority over complete acute correction of every fracture and occlusal discrepancy. Staged reconstruction and coordinated psychiatric and internal medicine care are essential components of definitive management.