Management of weapon injuries to the craniofacial skeleton

One thousand one hundred thirty-five patients suffering from different types of facial injuries caused by various weapons were treated in two university hospitals in Tehran, Iran from 1984 to 1990. The referred patients suffered from one of three types of facial injuries: soft-tissues injuries, 9.16% (N = 104); bone fractures, 18.15% (N = 206); and soft-tissue injuries and bone fractures (mixed injuries), 72.69% (N = 825). The number of male patients was greater than females (1,123 males and 12 females). Anatomically the facial injuries were classified into seven groups (lower third; middle third; upper third; lower and middle third; lower and upper third; middle and upper third; and lower, middle, and upper third). Lower-third facial injuries were the most common injuries, 72.60% (N = 824); followed by the middle-third injuries, 36.30% (N = 412); and the upper-third injuries, 20% (N = 227). The mandible was the most common site of injury in the lower-third injuries, zygomatico-orbital fractures were the most common site in the middle-third injuries, and the frontal bone was the most common site in the upper-third injuries. Of the total number of patients, 3.17% were children (N = 36) with different types of maxillofacial injuries. The majority of the injuries (52.42%; N = 595) were from bullets. The most common injuries not associated with maxillofacial injuries were head and ocular injuries. The least common were abdominal injuries. The head injuries were classified into five grades according to clinical and computed tomographic findings. Treatment of facial injuries ranged from minor repair and/or closed reduction to major soft-tissue and/or bone reconstruction. Postinjury complications were very high. The follow-up period ranged from 3 months to 3 years. The aim of this study is to add our experience in the management of facial injuries to the literature.