- Email: [email protected]
Philip Maloney Trauma Lecture
Symposia
PHILIP MALONEY TRAUMA LECTURE Presented on Friday, October 4, 4:35 pm - 5:15 pm
Ballistic Injuries of the Maxillofacial Region Richard H. Haug, DDS, Lexington, KY Trauma remains the leading cause of death and disability for children and young adults in America. The frequency of injury by firearms is second only to motor vehicle collisions for this age group. Ballistics research this past decade has provided a greater understanding of the biomechanics associated with penetrating injury, the interactions of the projectile and specific tissue types, and resultant damage. Rifles continue to provide the most devastating injuries to both hard and soft tissues due to their velocity rather than the mass of the projectile fired. Skin, muscle, and bone are frequently avulsed with this type of wounding mechanism. Nerves and vessels may be sheared. Handguns induce less mortal damage. Comminution of the mandible and drill-hole defects of the midface are common. Nerves and blood vessels are frequently pushed aside. The injuries produced by shotguns are dependent on the distance between the firearm and victim and are associated with the scatter of multiple projectiles. The damage inflicted
14
ranges between that of the rifle and handgun. As with all traumatic episodes, the first focus of attention should be directed toward both the establishment and maintenance of the airway, followed by control of hemorrhage and assurance of circulation. With all head and neck injuries the cervical spine should be protected. A thorough clinical and imaging examination should follow. Medical management should include the consideration of fluid replacement, antibiotics directed toward cutaneous, nasal, and oral contaminants, and tetanus immunization. Primary reconstruction of the damaged tissues is preferred. This may need to be delayed until infection or inflammation subsides, venous congestion has been minimized, and necrotic tissues have been de´brided. It must be remembered that treatment should be based on the nature of the wound rather than the type of firearm inflicting the injury. References Fackler ML: Gunshot wound review. Ann Emerg Med 28:194, 1996 Dementriades D, Chahwan S, Gomez H, et al: Initial evaluation and management of gunshot wounds to the face. J Trauma 45:39, 1998 Hollier L, Grantcharova EP, Kattash M: Facial gunshot wounds: A 4-year experience. J Oral Maxillofac Surg 59:277, 2001
AAOMS • 2002
PHILIP MALONEY TRAUMA LECTURE Presented on Friday, October 4, 4:35 pm - 5:15 pm
Ballistic Injuries of the Maxillofacial Region Richard H. Haug, DDS, Lexington, KY Trauma remains the leading cause of death and disability for children and young adults in America. The frequency of injury by firearms is second only to motor vehicle collisions for this age group. Ballistics research this past decade has provided a greater understanding of the biomechanics associated with penetrating injury, the interactions of the projectile and specific tissue types, and resultant damage. Rifles continue to provide the most devastating injuries to both hard and soft tissues due to their velocity rather than the mass of the projectile fired. Skin, muscle, and bone are frequently avulsed with this type of wounding mechanism. Nerves and vessels may be sheared. Handguns induce less mortal damage. Comminution of the mandible and drill-hole defects of the midface are common. Nerves and blood vessels are frequently pushed aside. The injuries produced by shotguns are dependent on the distance between the firearm and victim and are associated with the scatter of multiple projectiles. The damage inflicted
14
ranges between that of the rifle and handgun. As with all traumatic episodes, the first focus of attention should be directed toward both the establishment and maintenance of the airway, followed by control of hemorrhage and assurance of circulation. With all head and neck injuries the cervical spine should be protected. A thorough clinical and imaging examination should follow. Medical management should include the consideration of fluid replacement, antibiotics directed toward cutaneous, nasal, and oral contaminants, and tetanus immunization. Primary reconstruction of the damaged tissues is preferred. This may need to be delayed until infection or inflammation subsides, venous congestion has been minimized, and necrotic tissues have been de´brided. It must be remembered that treatment should be based on the nature of the wound rather than the type of firearm inflicting the injury. References Fackler ML: Gunshot wound review. Ann Emerg Med 28:194, 1996 Dementriades D, Chahwan S, Gomez H, et al: Initial evaluation and management of gunshot wounds to the face. J Trauma 45:39, 1998 Hollier L, Grantcharova EP, Kattash M: Facial gunshot wounds: A 4-year experience. J Oral Maxillofac Surg 59:277, 2001
AAOMS • 2002