Postoperative Complications in Primary Definitive Management of Hard and Soft Tissues in Mandibular Gunshot Injuries; A Review of 47 Cases

Abstract

Background: Firearm injuries cause significant morbidity and mortality among its victims. The type and extent of tissue damage vary from simple small size wound to a large soft tissue or skeletal defect. The selection of the appropriate surgical technique is as important as the timing because incorrect selection or improper application of surgical techniques may also lead to infection, sequestration, wound dehiscence, graft rejection, facial deformity and subsequent re-visional operations. Objective: The present study, carried out at Oral and Maxillofacial Surgery department, King Edward Medical University/ Mayo Hospital, Lahore, was aimed at highlighting the frequency of Postoperative complications in primary definitive management of hard and soft tissues in mandibular gunshot injuries. Study design: Descriptive case series. Setting: Department of Oral and Maxillofacial Surgery, King Edward Medical University/ Mayo Hospital, Lahore, from November 2010 to November 2012; including 6 months follow up. Patients and methods: The study was conducted on 47 patients. All patients suffered gunshot injuries to the mandible and had soft and hard tissue defects at a single site. Patients ranged in age from 17 to 54 years with a mean age of 32.31 years. Males dominated in the study and were n=37 and females n=10. All patients were treated definitively in the first

operation by addressing the hard and soft tissue defects. Results: All had single site fracture with angle of the mandible being most common 27 (57.44%). For reconstruction of soft tissue defect local advancement by undermining and primary closure was carried out in 35 (74.47%) patients, buccal pad of fat in 4 (8.51%) patient, deltopectoral flap in 5 (10.64%) patients and skin graft in 3 (6.38%) patient. For hard tissue reconstruction, nonvascularized bone graft was given in all cases i.e. n=47 (100%). Iliac crest bone graft was given in 34 (72.34%) patients, rib graft in 6 (12.77%) patients and symphyseal outer cortex bone graft in 7 (14.89%) patients. Post-operative complications were noted in terms of infection, plate exposure, plate fracture and malocclusion which appeared to be 9 (19.1%), 5 (10.6%), 2 (4.3%), 5 (10.6%) respectively. Conclusion: All patients in this series required surgical intervention for treatment of their facial gunshot wounds. Primary definitive hard and soft tissue management can be considered in patients suffering from gunshot injuries to the mandible. Although post-operative complications can result at higher rates in such injuries yet properly selected surgical techniques and post-operative infection control can produce excellent desired esthetic and functional results.