Gunshot wounds to the maxillofacial region: The Royal Adelaide Hospital’s experience — The Association Specialists
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Gunshot wounds to the maxillofacial region: The Royal Adelaide Hospital’s experience (#9)

Kenneth C.V. Sun 1 , Kim Tsao 1 , Andrew H.A. Cheng 1 , Paul Sambrook 1 , Alastair Goss 1
  1. Oral and Maxillofacial Surgery Unit, Royal Adelaide Hospital, Adelaide, SA, Australia

Background:

Firearm trauma causing injuries and death is uncommon in Australia. The severity of injury resulting from facial gunshot wounds varies according to the calibre of the weapon used and the distance from which the patient is shot. Early management of these patients must focus on the basics of resuscitation, with attention given to the status of the airway1 . Subsequent management of these patients becomes more controversial. Numerous series in the literature advocate early aggressive intervention for 1-stage reconstruction of all involved structures2 3 4 . However, several series published in the literature favour a more conservative approach, advocating non-operative management of these injuries5 6 7 

Objectives:

Describe the experience with firearm trauma causing injuries to the maxillofacial region and to evaluate the management and outcome in these patients in an Australian capital city's hospital.

Methods: 

A retrospective casenotes review was performed. 3 patients were identified with keyword search from the facial trauma data base of the Maxillofacial Surgery Unit at the Royal Adelaide Hospital. Demography, mechanism of injures and management were recorded and compared.

Principal findings:

All three of the patients were male with age ranging from 30 to 60 years. 1 out of 3 patients was treated with reconstruction plate, the second patient was managed with external fixateur and the last patient is being treated as a delayed surgical treatment patient.

Conclusions:

All patients in this series required surgical intervention for treatment of their facial gunshot wounds. Facial gunshot wounds management remains a controversy because of the rarity in Australia. There is no “hard and fast” rules for management of these patients, management to be individualised based on needs. Further to surgical management, patient should have psychological assessment during the course of care and ongoing support should be provided to patient as part of their management. 

  1. Dolin, James DDS; Scalea, Thomas MD; Mannor, Louis DDS; Sclafani, Salvatore MD; Trooskin, Stanley MD: The Management of Gunshot Wounds to the face. J Trauma 1992 33(4): 508-514
  2. Gruss JS, Antonyshyn O, Phillips JH: Early definitive bone and soft-tissue reconstruction of major gunshot wounds to the face. Plast Reconstr Surg 1991 87: 436
  3. Clark N, Birely B, Manson PN: High-energy ballistic and avulsive facial injuries: Classification, patterns, and an algorithm for primary reconstruction. Plast Reconstr Surg 1996 98: 583
  4. Chen AY, Stewart MG, Raup G: Penetrating injuries to the face. Otolaryngol Head Neck Surg 1996 115:464
  5. Kihtir T, Ivatury RR, Simon RJ: Early management of civilian gunshot wounds to the face. J Trauma 1993 35:569
  6. Demetriades D, Chahwan S, Gomez H: Initial evaluation and management of gunshot wounds to the face. J Trauma 1998: 45:39
  7. Williams CN, Cohen M, Schultz RC: Immediate and long term management of gunshot wounds to the lower face. Plast Reconstr Surg 1988 82:433
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