Low-velocity gunshot wounds to the maxillofacial complex

Area of Science:

• Trauma Surgery
• Maxillofacial Surgery
• Ballistics

Background:

• Literature on gunshot wounds primarily focuses on high-velocity military injuries.
• A distinct clinical profile exists for low-velocity gunshot wounds to the maxillofacial complex.

Purpose of the Study:

• To differentiate clinical presentations of low-velocity versus high-velocity maxillofacial gunshot wounds.
• To classify damage to vital structures in the maxillofacial complex from low-velocity missiles.
• To outline optimal management strategies for low-velocity maxillofacial gunshot wounds.

Main Methods:

• Retrospective review of 66 cases of low-velocity gunshot wounds to the maxillofacial complex (1971-1978).
• Classification of injuries based on anatomic location: supra-orbital, mid-face, and lower face.
• Analysis of associated vital structure damage (neurological, ocular, vascular, airway).

Main Results:

• Supra-orbital injuries (28 cases) frequently involved neurological damage (20 cases).
• Mid-face injuries (24 cases) impacted orbits/globes (8 cases).
• Lower face injuries (14 cases) included carotid lacerations (3 cases) and airway obstruction (2 cases requiring tracheostomy).
• Low infection rate (4 cases) managed with debridement, antibiotics, and drainage.

Conclusions:

• Low-velocity gunshot wounds to the maxillofacial complex have specific injury patterns and management needs.
• Prompt debridement, wound closure, antibiotic use, fracture stabilization, and appropriate airway management are crucial.
• Arteriographic studies and timely intervention minimize complications.