Abstract
Ballistic trauma is a serious health issue with significant costs to physical, psychosocial,
economic, and societal well-being. It may be caused from firearms, explosive devices,
or any other projectile forces, and is characterized by severe tissue loss and evolving
tissue devitalization. This review covers mechanism, diagnosis, and management of
ballistic maxillofacial trauma, specifically. Initial evaluation includes stabilization
of airway, bleeding, and circulation, followed by assessment of other injuries. The
overall degree of tissue damage is determined by intrinsic patient factors and extrinsic
projectile factors. Management of ballistic injuries has shifted toward advocation
for early operative repair with the advent of antibiotics and advanced techniques
in maxillofacial reconstruction. Appropriate timing and method of reconstruction should
be carefully selected on a case-by-case basis. While ballistic trauma research is
limited to studies biased by institutional practices, areas for further study identified
from current literature include guidelines directing timing of reconstructive surgery;
thresholds for free tissue transfer; handling of retained projectiles; incidence of
surgical complications; and clinical outcomes for computer-aided surgical repair of
these highly destructive injuries.
Keywords
ballistic - projectile - gunshot wounds - maxillofacial trauma - facial injuries -
free tissue transfer
