Surgical Planning of Ballistic Facial Injuries

Abstract

Ballistic facial injuries often cause widespread damage, distorting the native anatomy. Apart from initial resuscitative measures, these injuries require extensive employment of reconstructive techniques to restore the patient's form and function. As such, thoughtful data acquisition from both physical exam and radiographic studies optimizes surgical planning to achieve optimal patient outcomes. Specifically, virtual surgical planning has been shown to decrease intraoperative times and achieve enhanced functional and aesthetic outcomes when compared to traditional methods. The purpose of this chapter is to review surgical planning in the context of ballistic facial injuries, with a specific focus on virtual surgical planning.

Keywords

ballistic facial injury - surgical planning - virtual surgical planning - VSP - mandible - occlusion

Note

USU-WRNMMC Surgery: The opinions or assertions contained herein are the private ones of the author/speaker and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the U.S. Government.

Publication History

Article published online:
26 March 2025

• References

• 1 Clark N, Birely B, Manson PN. et al. High-energy ballistic and avulsive facial injuries: classification, patterns, and an algorithm for primary reconstruction. Plast Reconstr Surg 1996; 98 (04) 583-601
• 2 Garajei A, Modarresi A, Arabkheradmand A, Shirkhoda M. Functional and esthetic outcomes of virtual surgical planning versus the conventional technique in mandibular reconstruction with a free fibula flap: A retrospective study of 24 cases. J Craniomaxillofac Surg 2024; 52 (04) 454-463
• 3 Volk AS, Shokri T, Sokoya M, Ducic Y, Hollier Jr LH. Facial Gunshot Wounds. Facial Plast Surg 2019; 35 (06) 578-583
• 4 Robertson BC, Manson PN. High-energy ballistic and avulsive injuries. A management protocol for the next millennium. Surg Clin North Am 1999; 79 (06) 1489-1502 , xi
• 5 Rodriguez ED, Martin M, Bluebond-Langner R, Khalifeh M, Singh N, Manson PN. Microsurgical reconstruction of posttraumatic high-energy maxillary defects: establishing the effectiveness of early reconstruction. Plast Reconstr Surg 2007; 120 (7, suppl 2): 103S-117S
• 6 Farber SJ, Latham KP, Kantar RS, Perkins JN, Rodriguez ED. Reconstructing the Face of War. Mil Med 2019; 184 (7-8): e236-e246
• 7 Thakker JS, Pace M, Lowe I, Jung P, Herford AS. Virtual Surgical Planning in Maxillofacial Trauma. Atlas Oral Maxillofac Surg Clin North Am 2019; 27 (02) 143-155
• 8 Kazi AA, Lee TS, Vincent A, Sokoya M, Sheen D, Ducic Y. The Role of External Fixation in Trauma and Reconstruction of the Mandible in the Age of Rigid Fixation. Facial Plast Surg 2019; 35 (06) 614-622
• 9 Betz S, Kim RY, Jelmini J, Williams FC, Hammer DA. Is Maxillary Jaw in a Day Feasible?. Atlas Oral Maxillofac Surg Clin North Am 2024; 32 (02) 141-149
• 10 Sukato DC, Hammer D, Wang W, Shokri T, Williams F, Ducic Y. Experience With “Jaw in a Day” Technique. J Craniofac Surg 2020; 31 (05) 1212-1217
• 11 Saad A, Winters R, Wise MW, Dupin CL, St Hilaire H. Virtual surgical planning in complex composite maxillofacial reconstruction. Plast Reconstr Surg 2013; 132 (03) 626-633
• 12 Vyas K, Suchyta M, Gibreel W. et al. Virtual Surgical Planning and 3D-Printed Surgical Guides in Facial Allotransplantation. Semin Plast Surg 2022; 36 (03) 199-208
• 13 Efanov JI, Roy AA, Huang KN, Borsuk DE. Virtual Surgical Planning: The Pearls and Pitfalls. Plast Reconstr Surg Glob Open 2018; 6 (01) e1443
• 14 Singh GD, Singh M. Virtual Surgical Planning: Modeling from the Present to the Future. J Clin Med 2021; 10 (23) 5655
• 15 Maisi S, Dominguez M, Gilong PC. et al. In-house virtual surgical planning for mandibular reconstruction with fibula free flap: Case series and literature review. Ann 3D Print Med 2023; 10: 100109
• 16 Chim H, Wetjen N, Mardini S. Virtual surgical planning in craniofacial surgery. Semin Plast Surg 2014; 28 (03) 150-158
• 17 Rohner D, Jaquiéry C, Kunz C, Bucher P, Maas H, Hammer B. Maxillofacial reconstruction with prefabricated osseous free flaps: a 3-year experience with 24 patients. Plast Reconstr Surg 2003; 112 (03) 748-757
• 18 Schepers RH, Raghoebar GM, Vissink A. et al. Fully 3-dimensional digitally planned reconstruction of a mandible with a free vascularized fibula and immediate placement of an implant-supported prosthetic construction. Head Neck 2013; 35 (04) E109-E114
• 19 Sung J, Khatib B. Pearls and Pitfalls for the Reconstruction of Gunshot Injuries to the Face. In: Amin D, Marwan H. eds. Pearls and Pitfalls in Oral and Maxillofacial Surgery. Springer International Publishing; 2024: 101-107
• 20 Benateau H, Chatellier A, Caillot A, Labbe D, Veyssiere A. Computer-assisted planning of distraction osteogenesis for lower face reconstruction in gunshot traumas. J Craniomaxillofac Surg 2016; 44 (10) 1583-1591
• 21 Preparation for intraoperative navigation. AO Surgery Reference. Accessed November 18, 2024. https://surgeryreference.aofoundation.org/cmf/further-reading/cas-preparation-for-intraoperative-navigation
• 22 Bergeron L, Bouchard S, Bonapace-Potvin M, Bergeron F. Intraoperative Surgical Navigation Reduces the Surgical Time Required to Treat Acute Major Facial Fractures. Plast Reconstr Surg 2019; 144 (04) 923-931
• 23 Virtual planning and intraoperative navigation. AO Surgery Reference. Accessed November 18, 2024. https://surgeryreference.aofoundation.org/cmf/trauma/midface/further-reading/computer-assisted-surgery-orbit-virtual-planning-and-intraoperative-navigation