Department of Otolaryngology, Washington University in St Louis School of Medicine, St Louis, Missouri.
InPrint, Washington University in St Louis School of Medicine, St Louis, Missouri.
Facial Plast Surg. 2023 Jun;39(3):237-252. doi: 10.1055/s-0043-1764347. Epub 2023 Mar 16.
Ballistic trauma is a serious health issue with significant costs to physical, psychosocial, economic, and societal well-being. It may be caused from firearms, explosive devices, or any other projectile forces, and is characterized by severe tissue loss and evolving tissue devitalization. This review covers mechanism, diagnosis, and management of ballistic maxillofacial trauma, specifically. Initial evaluation includes stabilization of airway, bleeding, and circulation, followed by assessment of other injuries. The overall degree of tissue damage is determined by intrinsic patient factors and extrinsic projectile factors. Management of ballistic injuries has shifted toward advocation for early operative repair with the advent of antibiotics and advanced techniques in maxillofacial reconstruction. Appropriate timing and method of reconstruction should be carefully selected on a case-by-case basis. While ballistic trauma research is limited to studies biased by institutional practices, areas for further study identified from current literature include guidelines directing timing of reconstructive surgery; thresholds for free tissue transfer; handling of retained projectiles; incidence of surgical complications; and clinical outcomes for computer-aided surgical repair of these highly destructive injuries.
弹道创伤是一个严重的健康问题，对身体、心理社会、经济和社会福利都有重大影响。它可能由枪支、爆炸装置或任何其他投射物引起，其特征是严重的组织损失和不断发展的组织失活。本综述专门涵盖了弹道性颌面创伤的机制、诊断和治疗。初始评估包括气道、出血和循环的稳定，然后评估其他损伤。组织损伤的总体程度取决于内在的患者因素和外在的投射物因素。随着抗生素和颌面重建技术的进步，弹道损伤的治疗已经转向提倡早期手术修复。应根据具体情况仔细选择适当的重建时机和方法。虽然弹道创伤研究仅限于受机构实践偏见的研究，但从现有文献中确定的进一步研究领域包括指导重建手术时机的指南；游离组织移植的阈值；处理残留弹片；手术并发症的发生率；以及计算机辅助修复这些高破坏性损伤的临床效果。
