Shuker Sabri T
1Formerly Head of Department of Maxillofacial Surgeon, Baghdad Medical City, Baghdad, Iraq.
West Bloomfield, USA.
J Maxillofac Oral Surg. 2019 Mar;18(1):124-130. doi: 10.1007/s12663-018-1107-2. Epub 2018 Mar 29.
Current ballistics and high-energy explosion possess unnoticed, new and significant biophysics and pathophysiology wounding effects that are unique in comparison with civilian trauma. The primary blast wave effects of compressed air due to explosion lead to tattered and crushed eggshell injuries to the upper central midface (UCM). High-energy shell fragments of various shapes and sizes cause extensive destruction and are different from assault rifle's bullets that cause high energy transfer to the creating a temporary cavitation.
Twenty-one patients with unquantifiable war injuries were selected. The emergency managment of lifesaving facial war injuries starts with life threatening hemorrahge or air compramise. This article describes immediate management of medial canthal tendon (MCT), intercanthal region and severe nasal war injuries.
The utilized procedure obtained good results compared to the results of cases treated only by applying a classic approach of civilian fractures.
Treatments of UCM injuries are the most difficult since UCM includes the esthetic, physiologic, and anatomical regions of the face. The proposed technique provides immediate excellent stability for soft tissues, bone, and cartilage and is well tolerated in the long term by both the tissue and the patient. Most of the times, victims are treated with limited resources, deficient subspecialty, massive injuries, during mass casualties, and a single surgeon must have to handle all these within a short period of time. UCM injuries are really concerning since this region is the core of facial esthetic and function.
当前的弹道学和高能爆炸具有未被注意到的、新的且显著的生物物理学和病理生理学致伤效应，与平民创伤相比具有独特性。爆炸产生的压缩空气的原发性冲击波效应会导致面部中上部中央（UCM）出现蛋壳样撕裂和粉碎性损伤。各种形状和大小的高能弹片会造成广泛破坏，与突击步枪子弹不同，突击步枪子弹会导致高能量传递从而产生临时空化现象。
选择21例伤情无法量化的战争伤患者。挽救面部战争伤的紧急处理从威胁生命的出血或气道受损开始。本文描述了内眦韧带（MCT）、内眦区域和严重鼻部战争伤的即刻处理。
与仅采用平民骨折经典治疗方法的病例结果相比，所采用的手术方法取得了良好效果。
UCM损伤的治疗最为困难，因为UCM包括面部的美学、生理和解剖区域。所提出的技术能为软组织、骨骼和软骨提供即刻良好的稳定性，并且组织和患者长期耐受性良好。大多数情况下，受害者在资源有限、专科不足、伤势严重、处于大规模伤亡期间接受治疗，而且单个外科医生必须在短时间内处理所有这些情况。UCM损伤确实令人担忧，因为该区域是面部美学和功能的核心。
