Treatment of facial gunshot injuries

Patients with gunshot injuries in the maxillofacial region should be resuscitated and subjected to a general examination in the emergency room. Chest X-rays and head CT scans should be performed on a routine basis, and in selected cases angiography and plain X-ray films of the cervical columns are also recommended. Treatment of the facial defects depends to some degree on the type of firearm involved, i.e. high velocity rifle, low velocity weapon or shotgun. The traditional treatment for war and civilian gunshot injuries to the face has been debridement, soft tissue closure and conservative treatment of fractures, with closed reduction and external fixation. This treatment may leave inadequate stabilization of remaining bone fragments, with collapse and later contraction of soft tissue. It fails to take advantage of the modern craniofacial and microsurgical techniques used in a more recent approach that can be termed initial final treatment of gunshot wounds. This treatment modality is recommended for civilian low velocity gunshot injuries and, after repeated debridements, also for injuries caused by shotguns and high velocity weapons.