Bicak Adam, Hale Jessica, Day Kristopher M
Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA.
Cureus. 2021 Feb 28;13(2):e13611. doi: 10.7759/cureus.13611.
Ballistic maxillofacial injuries are highly destructive, producing significant morbidity and mortality. Survivors' defects pose unique reconstructive challenges, such as loss of periorbital bone stock in upper midface injuries. While orbital reconstruction has transitioned from primarily autologous grafts to alloplastic implants, ballistic trauma remains a niche that warrants the use of autologous bone equally with alloplastic materials. We report a case of an upper midface gunshot wound in a 20-year-old male producing bilateral comminuted medial orbital wall fractures. Reconstruction utilized bilateral split-thickness calvarial bone grafts through preseptal transcaruncular transconjunctival incisions. This case illustrates the utility of autologous bone grafts in the setting of lost periorbital bone stock and minimizing foreign body in surgical fields at high risk of infection or complication. Further studies are necessary to refine the indications for autologous bone grafting and its benefit relative to alloplastic implants in ballistic periorbital trauma.
弹道性颌面损伤具有高度破坏性，会导致显著的发病率和死亡率。幸存者的缺损带来了独特的重建挑战，比如面中部上份损伤时眶周骨量的丧失。虽然眼眶重建已从主要使用自体移植物转变为使用异体植入物，但弹道创伤仍是一个特殊领域，同样需要使用自体骨和异体材料。我们报告一例20岁男性面中部上份枪伤病例，该病例导致双侧眶内侧壁粉碎性骨折。通过经泪前嵴、经泪阜、经结膜切口，利用双侧分层颅骨骨移植进行重建。该病例说明了自体骨移植在眶周骨量丧失的情况下的效用，以及在感染或并发症高风险的手术区域将异物减至最少的作用。有必要进行进一步研究，以完善自体骨移植的适应症及其在弹道性眶周创伤中相对于异体植入物的益处。
