Early management of gunshot injuries to the face in civilian practice

Abstract

Background: Gunshot injuries to the face in civilian practice are rarely reported. Potential complications in the Emergency Department can have catastrophic consequences, and inappropriate operative management of the facial soft and skeletal tissues are related to outcome.

Methods: A structured diagnostic and management approach is used in our Trauma Unit to deal with gunshot wounds to the face. A retrospective study of 55 patients who sustained gunshot injury to the face was conducted over a 6(1/2)-year period. Demographic details, mechanism of injury, and mode of presentation and management were recorded. Mortality and morbidity data were collated.

Results: There were 51 male and 4 female patients. All injuries were caused by low-velocity gunshots, except for one that was a shotgun injury. Overall, 28 of the 55 patients (50%) underwent orotracheal intubation on scene or in the resuscitation room, and 2 had cricothyroidotomy. In addition to the maxillofacial trauma, associated injuries were common. Forty patients underwent operation for maxillofacial trauma, 34 on the day of admission and the remaining 6 within 5 days of injury. Multiple operations over a 2-week period were necessary for 18 of the 40 patients. Complications directly related to the gunshot injury to the face were very limited. Mortality was related to associated injuries.

Conclusions: Gunshot injury to the face in civilian violence is a "benign" condition as long as the Patient's airway is kept patent and hemorrhage is controlled. Early operative intervention for repair of the soft and skeletal facial structures leads to satisfactory results. Mortality directly related to the facial trauma is uncommon.