Gant T D, Epstein L I
J Trauma. 1979 Sep;19(9):674-7. doi: 10.1097/00005373-197909000-00007.
A review of the past literature of gunshot wounds indicates that the clinical material deals mainly with high-velocity missile injuries from military experience. A series of 66 cases of low-velocity gunshot wounds to the maxillofacial complex at San Francisco General Hospital between 1971 and 1978 indicates a clinical difference between injuries caused by low-velocity as compared to previously reported high-velocity missiles. Damage to vital structures resulting from missile injury to the maxillofacial complex are classified in three anatomic areas: 1) supra-orbital (28 cases of which 20 involved neurological damage); 2) mid-face (24 cases of which 8 involved the orbits and/or globe); 3) lower face (14 cases, of which 3 involved laceration of the carotid and 2 involved airway obstruction necessitating tracheostomy). The management of gunshot wounds to the maxillofacial area is outlined, emphasizing: 1) Debridement and prompt closure of intraoral wounds with antibiotic coverage: 2) Early stabilization of mandible fractures: 3) Indications for tracheostomy; 4) Arteriographic studies. In our series there were only four infections, which were treated easily with incision and drainage and appropriate antibiotic selection.
对过去关于枪伤的文献综述表明，临床资料主要涉及军事经验中的高速导弹伤。1971年至1978年间，旧金山总医院收治了66例颌面复合体低速枪伤病例，这表明低速枪伤与此前报道的高速导弹伤在临床上存在差异。颌面复合体导弹伤对重要结构造成的损伤按三个解剖区域分类：1）眶上区（28例，其中20例涉及神经损伤）；2）面中区（24例，其中8例涉及眼眶和/或眼球）；3）面下区（14例，其中3例涉及颈动脉撕裂，2例涉及气道阻塞需要气管切开）。本文概述了颌面区域枪伤的处理方法，重点强调：1）清创并及时缝合口腔内伤口并使用抗生素；2）早期稳定下颌骨骨折；3）气管切开的指征；4）动脉造影研究。在我们的病例系列中，仅出现4例感染，通过切开引流和适当选择抗生素很容易治愈。
