Management of self-inflicted gunshot wounds to the face: retrospective review from a single tertiary care trauma centre
Introduction
Self-inflicted facial gunshot wounds can result in devastating injuries to the facial structures and have a high mortality.1 They are particularly distressing injuries, and not just for the patient. The psychological milieu of the injury means that the mindset of the surgeon must be considered as well as that of the patient, because of the strong emotion evoked by the nature of the injury.
Early primary reconstruction has been advocated for the management of facial gunshot wounds that result from civilian interpersonal violence,2 but its merits and feasibility have not been investigated in isolated, self-inflicted, facial gunshot wounds. In contrast to most facial gunshot wounds that result from interpersonal violence, the weapon is held in close proximity to the face in self-inflicted wounds, which could potentially affect the outcomes of early primary reconstruction. The potential impact of the surgeon’s misgivings must be acknowledged because of the self-inflicted nature of the injury and the complexity of the reconstructive surgery,3 but this should not be a reason for delaying primary reconstruction.
The purpose of this study was to analyse retrospectively the management of subjects who were seen with self-inflicted facial gunshot wounds at a tertiary care centre. The investigators hypothesised that the principles of early primary reconstruction could be successfully used in their management.
Section snippets
Methods
The institutional ethics review board approved this retrospective study. The group studied comprised all subjects who presented to a tertiary care trauma centre with a self-inflicted facial gunshot wound between January 2002 and December 2012.
To be included subjects had to be alive on arrival with definitive evidence of a self-inflicted facial gunshot wound (history, eye witness’s account, opinion of law enforcement officer, necropsy report, or strong medical opinion). The necropsy report (if
Results
A total of 76 subjects, 65 men and 11 women (mean (range) age 44 (18–83) years) met the inclusion criteria, 29 of whom died, 13 within 24 hours of presentation. None of those who died within 24 hours was operated on. Significantly more subjects with submental and intraoral entry sites survived the first 24 hours (p = 0.001). Table 1 gives a summary of interventions and outcomes. Emergency control of haemorrhage was by interventional radiology (n = 3) or in the operating theatre (n = 2). Packing was used
Discussion
Self-inflicted facial gunshot wounds are a major challenge to the oral and maxillofacial surgeon, and we sought to analyse the management of such subjects who were seen at a tertiary care centre to evaluate the hypothesis that the principles of early primary reconstruction can be successfully used in their management.
Previous publications have supported the use of early primary reconstruction for civilian, self-inflicted, facial gunshot wounds.4, 5, 6 This results from experience of the
Conclusion
Most self-inflicted facial gunshot wounds of the upper and midface can be managed with early primary reconstruction. Submental wounds were more likely to be managed with delayed primary reconstruction, although the reason for this was not clear. The possibility of increasing the use of early primary reconstruction in those with submental self-inflicted facial gunshot wounds should be investigated.
Conflict of interest
We have no conflicts of interest.
Ethics statement/confirmation of patients’ permission
The hospital Institutional Review Board granted permission for the study. Patients’ permission was not required as no identifying data are presented.
Acknowledgements
The authors thank Betsy Crammer for her help.
References (21)
- et al.
High-energy ballistic and avulsive injuries. A management protocol for the next millennium
Surg Clin North Am
(1999) Maxillofacial trauma reconstruction
Facial Plast Surg Clin N Am
(2009)- et al.
Oral and maxillofacial injuries experienced in support of Operation Iraqi Freedom I and II
Oral Maxillofac Surg Clin North Am
(2005) - et al.
Maxillofacial trauma treatment protocol
Oral Maxillofacial Surg Clin N Am
(2005) Penetrating injuries of the face: delayed versus primary treatment—considerations for delayed treatment
J Oral Maxillofac Surg
(2007)- et al.
Maxillofacial gunshot injuries at an urban level I trauma center—10-year analysis
J Oral Maxillofac Surg
(2015) Primary treatment of penetrating injuries of the face
J Oral Maxillofac Surg
(2007)- US Centers for Disease Control and Prevention WISQARS database. Available from URL:...
- et al.
Gunshot wounds to the head and neck
Curr Opin Otolaryngol Head Neck Surg
(2007) - et al.
Self-inflicted shotgun wounds of the face: surgical and psychiatric considerations
Otolaryngol Head Neck Surg
(1988)
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