Penetrating facial trauma: a management plan.

Penetrating wounds of the face present a spectrum of injuries and multiple management dilemmas. The surgeon's first concern remains the establishment of a proper airway and control of life-threatening injuries. Selected ancillary diagnostic procedures should be used to confirm vascular, aerodigestive, or central nervous system injuries. Diagnosis of injuries may require arteriography, endoscopic examination, barium studies, computerized tomography, and detailed ophthalmologic examination. We review 16 cases of penetrating facial trauma treated at the University of South Alabama Trauma Center over a one-year period. The injuries resulted from 13 gunshot wounds and three stab wounds. Injuries of the central nervous system occurred in three patients, mandibular fractures in four, optic nerve or globe injury in three, and maxillary sinus fracture in seven. Our experience with these patients demonstrates the spectrum of injuries and serves as a basis for a management algorithm.