Hostname: page-component-cd9895bd7-gvvz8 Total loading time: 0 Render date: 2024-12-29T01:49:34.008Z Has data issue: false hasContentIssue false

Maxillofacial Gunshot Wounds

Published online by Cambridge University Press:  14 April 2015

Olga Maurin*
Affiliation:
Emergency Department, Fire Brigade of Paris, Paris, France
Stanislas de Régloix
Affiliation:
Military Hospital of Clamart, Head and Neck Surgery Department, Clamart, France
Stéphane Dubourdieu
Affiliation:
Emergency Department, Fire Brigade of Paris, Paris, France
Hugues Lefort
Affiliation:
Emergency Department, Fire Brigade of Paris, Paris, France
Stéphane Boizat
Affiliation:
Emergency Department, Fire Brigade of Paris, Paris, France
Benoit Houze
Affiliation:
Emergency Department, Fire Brigade of Paris, Paris, France
Jennifer Culoma
Affiliation:
Emergency Department, Fire Brigade of Paris, Paris, France
Guillaume Burlaton
Affiliation:
Emergency Department, Fire Brigade of Paris, Paris, France
Jean-Pierre Tourtier
Affiliation:
Emergency Department, Fire Brigade of Paris, Paris, France
*
Correspondence: Olga Maurin, MD Emergency Department Fire Brigade of Paris 1, place Jules Renard 75017 Paris, France E-mail: [email protected]

Abstract

The majority of maxillofacial gunshot wounds are caused by suicide attempts. Young men are affected most often. When the lower one-third of the face is involved, airway patency (1.6% of the cases) and hemorrhage control (1.9% of the cases) are the two most urgent complications to monitor and prevent. Spinal fractures are observed with 10% of maxillary injuries and in 20% of orbital injuries. Actions to treat the facial gunshot victim need to be performed, keeping in mind spine immobilization until radiographic imaging is complete and any required spinal stabilization accomplished. Patients should be transported to a trauma center equipped to deal with maxillofacial and neurosurgery because 40% require emergency surgery. The mortality rate of maxillofacial injuries shortly after arrival at a hospital varies from 2.8% to 11.0%. Complications such as hemiparesis or cranial nerve paralysis occur in 20% of survivors. This case has been reported on a victim of four gunshot injuries. One of the gunshots was to the left mandibular ramus and became lodged in the C4 vertebral bone.

MaurinO, de RégloixS, DubourdieuS, LefortH, BoizatS, HouzeB, CulomaJ, BurlatonG, TourtierJP. Maxillofacial Gunshot Wounds. Prehosp Disaster Med. 2015;30(3):14.

Type
Case Report
Copyright
© World Association for Disaster and Emergency Medicine 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Makhlouf, F, Scolan, V, Ferretti, G, Stahl, C, Paysant, F. Gunshot fatalities: correlation between post-mortem multi-slice computed tomography and autopsy findings: a 30-month retrospective study. Leg Med. 2013;15(3):145-148.CrossRefGoogle Scholar
2. Dobson, JE, Newell, MJ, Shepherd, JP. Trends in maxillofacial injuries in war-time (1914-1986). Br J Oral Maxillofac Surg. 1989;27(6):441-450.Google Scholar
3. Hollier, L, Grantcharova, EP, Kattash, M. Facial gunshot wounds: a 4-year experience. J Oral Maxillofac Surg. 2001;59(3):277-282.CrossRefGoogle Scholar
4. Papadopoulos, IN, Kanakaris, NK, Danias, N, et al. A structured autopsy-based audit of 370 firearm fatalities: contribution to inform policy decisions and the probability of the injured arriving alive at a hospital and receiving definitive care. Accid Anal Prev. 2013;50:667-677.Google Scholar
5. Levin, L, Zadik, Y, Peleg, K, Bigman, G, Givon, A, Lin, S. Incidence and severity of maxillofacial injuries during the second Lebanon War among Israeli soldiers and civilians. J Oral Maxillofac Surg. 2008;66(8):1630-1633.Google Scholar
6. Glapa, M, Kourie, JF, Doll, D, Degiannis, E. Early management of gunshot injuries to the face in civilian practice. World J Surg. 2007;31(11):2104-2110.Google Scholar
7. Alper, M, Totem, S, Cankayali, R, Songür, E. Gunshot wounds of the face in attempted suicide patients. J Oral Maxillofac Surg. 1998;56(8):930-933.Google Scholar
8. Kihtir, T, Ivatury, RR, Simon, RJ, Nassoura, Z, Leban, S. Early management of civilian gunshot wounds to the face. J Trauma. 1993;35(4):569-575; discussion 575-577.Google Scholar
9. Bono, CM, Heary, RF. Gunshot wounds to the spine. Spine J. 2004;4(2):230-240.Google Scholar
10. Tung, TC, Tseng, WS, Chen, CT, Lai, JP, Chen, YR. Acute life-threatening injuries in facial fracture patients: a review of 1,025 patients. J Trauma. 2000;49(3):420-424.Google Scholar
11. Ng, M, Saadat, D, Sinha, UK. Managing the emergency airway in Le Fort fractures. J Craniomaxillofac Trauma. 1998;4(4):38-43.Google ScholarPubMed
12. Dupanovic, M, Fox, H, Kovac, A. Management of the airway in multi-trauma. Curr Opin Anaesthesiol. 2010;23(2):276-282.Google Scholar
13. Brywczynski, JJ, Barrett, TW, Lyon, JA, Cotton, BA. Management of penetrating neck injury in the emergency department: a structured literature review. Emerg Med J. 2008;25(11):711-715.Google Scholar
14. Perry, M, Morris, C. Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 2: ATLS, maxillofacial injuries and airway management dilemmas. Int J Oral Maxillofac Surg. 2008;37(4):309-320.Google Scholar
15. Dunham, MC, Barraco, RD, Clark, DE, et al. Guidelines for emergency tracheal intubation immediately after traumatic injury. J Trauma. 2003;55(1):162-179.Google Scholar
16. Crosby, ET. Airway management in adults after cervical spine trauma. Anesthesiology. 2006;104(6):1293-1318.CrossRefGoogle ScholarPubMed
17. Lustenberger, T, Talving, P, Lam, L, et al. Unstable cervical spine fracture after penetrating neck injury: a rare entity in an analysis of 1,069 patients. J Trauma. 2011;70(4):870-872.Google Scholar
18. Isiklar, ZU, Lindsey, RW. Low-velocity civilian gunshot wounds of the spine. Orthopedics. 1997;20(10):967-972.CrossRefGoogle ScholarPubMed
19. Tourtier, JP, Pierret, C, Charbonnel, A, Auroy, Y. Cervical spine immobilization in the tactical environment. J Trauma. 2011;71(1):265.Google Scholar
20. Thiboutot, F, Nicole, PC, Trépanier, CA, Turgeon, AF, Lessard, MR. Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial. Can J Anesth. 2009;56(6):412-418.Google Scholar
21. Maurin, O, de Regloix, S, Caballé, D, Arvis, A-M, Perrochon, J-C, Tourtier, J-P. Choc neurogénique traumatique. Ann Fr Anesth Reanim. 2013;32(5):361-363.Google Scholar
22. Timmermann, A, Eich, C, Russo, SG, et al. Prehospital airway management: a prospective evaluation of anesthesia trained emergency physicians. Resuscitation. 2006;70(2):179-185.Google Scholar
23. Shimoyama, T, Kaneko, T, Horie, N. Initial management of massive oral bleeding after midfacial fracture. J Trauma. 2003;54(2):332-336;discussion 336.CrossRefGoogle ScholarPubMed
24. Vriens, MR, Leenen, LPH. Damage control of maxillofacial haemorrhage. Injury Extra. 2008;39(6):225-227.Google Scholar
25. Pusateri, AE, Holcomb, JB, Kheirabadi, BS, Alam, HB, Wade, CE, Ryan, KL. Making sense of the preclinical literature on advanced hemostatic products. J Trauma. 2006;60(3):674-682.Google Scholar
Supplementary material: Image

Maurin supplementary material

Maurin supplementary material 1

Download Maurin supplementary material(Image)
Image 18.6 MB