Abstract
Purpose
Current ballistics and high-energy explosion possess unnoticed, new and significant biophysics and pathophysiology wounding effects that are unique in comparison with civilian trauma. The primary blast wave effects of compressed air due to explosion lead to tattered and crushed eggshell injuries to the upper central midface (UCM). High-energy shell fragments of various shapes and sizes cause extensive destruction and are different from assault rifle’s bullets that cause high energy transfer to the tissue by creating a temporary cavitation.
Methods
Twenty-one patients with unquantifiable war injuries were selected. The emergency managment of lifesaving facial war injuries starts with life threatening hemorrahge or air compramise. This article describes immediate management of medial canthal tendon (MCT), intercanthal region and severe nasal war injuries.
Results
The utilized procedure obtained good results compared to the results of cases treated only by applying a classic approach of civilian fractures.
Conclusion
Treatments of UCM injuries are the most difficult since UCM includes the esthetic, physiologic, and anatomical regions of the face. The proposed technique provides immediate excellent stability for soft tissues, bone, and cartilage and is well tolerated in the long term by both the tissue and the patient. Most of the times, victims are treated with limited resources, deficient subspecialty, massive injuries, during mass casualties, and a single surgeon must have to handle all these within a short period of time. UCM injuries are really concerning since this region is the core of facial esthetic and function.
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References
Marc A (2014) Conflict and violence in the 21st century current trends as observed in empirical research and statistics. Chief Specialist, Fragility, Conflict and Violence World Bank Group
Cornelius C-P, Audigé L, Kunz C, Buitrago-Téllez CH, Rudderman R, Prein J (2014) The comprehensive AOCMF classification system: midface fractures—level 3 tutorial. Craniom Trauma Reconstr 7:568–591
Ellis E 3rd (1993) Sequencing treatment for naso-orbito-ethmoid fractures. J Oral Maxillofac Surg 51:543–558
Heine RD, Catone GA, Bavitz JB et al (1990) Naso-orbital-ethmoid injury: report of a case and review of the literature. Oral Surg Oral Med Oral Pathol 69:542–549
Bell RB, Dierks EJ, Homer L, Potter BE (2004) Management of cerebrospinal fluid leak associated with craniomaxillofacial trauma. J Oral Maxillofac Surg 62:676
Markowitz BL, Manson PN, Sargent L, Vander Kolk CA, Yaremchuk M, Glassman D, Crawley WA (1991) Management of the medial canthal tendon in nasoethmoid orbital fractures: the importance of the central fragment in classification and treatment. Plast Reconstr Surg 87:843–853
Shibuya TY, Chen VY, Oh YS (2008) Naso-orbito-ethmoid fracture management. Oper Tech Otolaryngol 19:140–144
Rosenberger E, Kriet JD, Humphrey C (2013) Management of nasoethmoid fractures. Curr Opin Otolaryngol Head Neck Surg 21:410–416
Slotnick JA (2010) Explosive threats and target hardening understanding explosive forces, its impact on infrastructure and the human body. In: Fourth International symposium on tunnel safety and security, Frankfurt am Main, Germany, March 17–19
Shuker ST (2010) Maxillofacial air containing cavities blast implosion injuries and management. J Oral Maxillofac Surg 68:93–100
Shuker ST (2016) Emergency management of high-energy shell fragment midface complex injuries. J Craniofac Surg 27:1308–1311
Bellamy RF, Zajtchuk R (1991) Assessing the effectiveness of conventional weapons. In: Bellamy RF, Zajtchuk R (eds) Textbook of military medicine, conventional warfare. VA: Office of the Surgeon General, United States Army, Falls Church, pp 55–69
Stefanopoulos PK, Hadjigeorgiou GF, Filippakis K, Gyftokostas D (2014) Gunshot wounds: a review of ballistics related to penetrating trauma. J Acute Dis 3:178–185
Petersen K, Hayes DK, Blice JP, Hale RG (2008) Prevention and management of infections associated with combat-related head and neck injuries. J Trauma Injury Infection Crit Care 64:S265–S276
Timoney PJ, Sokol JA, Hauck MJ et al (2012) Transcutaneous medial canthal tendon incision to the medial orbit. Ophthal Plast Reconstr Surg 28:140–144
Shuker ST (1988) Intra-nasal stabilization for severe nasal war injuries. J Craniomaxillofac Surg 16:120
Fox AJ, Tatum SA (2003) The coronal incision: sinusoidal, saw tooth, and postauricular techniques. Arch Facial Plast Surg 5:59–62
Priel A, Leelapatranurak K, Oh S, Korn BS, Kikkawa DO (2011) Medial canthal degloving injuries: the triad of telecanthus, ptosis, and lacrimal trauma. Plast Reconstr Surg 128:300
Gruss JS (1995) Craniofacial osteotomies and rigid fixation in the correction of post traumatic craniofacial deformities. Scand J Plast Reconstr Surg Hand Surg Suppl 27:83–95
Anastassov GE, Payami A, Zain Manji Z (2012) External fixation of unstable, “Flail” nasal fractures. Craniomaxillofac Trauma Reconstr 5:99–106
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The author thanks Miss Gillian Elder and staff at the West Bloomfield Library in Michigan for their assistance in this paper.
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No any financial interests the authors may have in companies or other entities that have an interest in the information in the Contribution (e.9., National Institutes of Health (NIH); Welcome Trust; Howard Hughes Medical Institute (HHMI); grants, advisory boards, employment, consultancies, contracts, honoraria, royalties, expert testimony, partnerships, or stock ownership in medically related fields).
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Shuker, S.T. Emergency Treatment of Blast, Shell Fragment and Bullet Injuries to the Central Midface Complex. J. Maxillofac. Oral Surg. 18, 124–130 (2019). https://doi.org/10.1007/s12663-018-1107-2
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DOI: https://doi.org/10.1007/s12663-018-1107-2