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Maxillofacial Gunshot Wounds

  • Olga Maurin (a1), Stanislas de Régloix (a2), Stéphane Dubourdieu (a1), Hugues Lefort (a1), Stéphane Boizat (a1), Benoit Houze (a1), Jennifer Culoma (a1), Guillaume Burlaton (a1) and Jean-Pierre Tourtier (a1)...


The majority of maxillofacial gunshot wounds are caused by suicide attempts. Young men are affected most often. When the lower one-third of the face is involved, airway patency (1.6% of the cases) and hemorrhage control (1.9% of the cases) are the two most urgent complications to monitor and prevent. Spinal fractures are observed with 10% of maxillary injuries and in 20% of orbital injuries. Actions to treat the facial gunshot victim need to be performed, keeping in mind spine immobilization until radiographic imaging is complete and any required spinal stabilization accomplished. Patients should be transported to a trauma center equipped to deal with maxillofacial and neurosurgery because 40% require emergency surgery. The mortality rate of maxillofacial injuries shortly after arrival at a hospital varies from 2.8% to 11.0%. Complications such as hemiparesis or cranial nerve paralysis occur in 20% of survivors. This case has been reported on a victim of four gunshot injuries. One of the gunshots was to the left mandibular ramus and became lodged in the C4 vertebral bone.

Maurin O , de Régloix S , Dubourdieu S , Lefort H , Boizat S , Houze B , Culoma J , Burlaton G , Tourtier JP . Maxillofacial Gunshot Wounds. Prehosp Disaster Med. 2015;30(3):1 4.


Corresponding author

Correspondence: Olga Maurin, MD Emergency Department Fire Brigade of Paris 1, place Jules Renard 75017 Paris, France E-mail:


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1. Makhlouf, F, Scolan, V, Ferretti, G, Stahl, C, Paysant, F. Gunshot fatalities: correlation between post-mortem multi-slice computed tomography and autopsy findings: a 30-month retrospective study. Leg Med. 2013;15(3):145-148.
2. Dobson, JE, Newell, MJ, Shepherd, JP. Trends in maxillofacial injuries in war-time (1914-1986). Br J Oral Maxillofac Surg. 1989;27(6):441-450.
3. Hollier, L, Grantcharova, EP, Kattash, M. Facial gunshot wounds: a 4-year experience. J Oral Maxillofac Surg. 2001;59(3):277-282.
4. Papadopoulos, IN, Kanakaris, NK, Danias, N, et al. A structured autopsy-based audit of 370 firearm fatalities: contribution to inform policy decisions and the probability of the injured arriving alive at a hospital and receiving definitive care. Accid Anal Prev. 2013;50:667-677.
5. Levin, L, Zadik, Y, Peleg, K, Bigman, G, Givon, A, Lin, S. Incidence and severity of maxillofacial injuries during the second Lebanon War among Israeli soldiers and civilians. J Oral Maxillofac Surg. 2008;66(8):1630-1633.
6. Glapa, M, Kourie, JF, Doll, D, Degiannis, E. Early management of gunshot injuries to the face in civilian practice. World J Surg. 2007;31(11):2104-2110.
7. Alper, M, Totem, S, Cankayali, R, Songür, E. Gunshot wounds of the face in attempted suicide patients. J Oral Maxillofac Surg. 1998;56(8):930-933.
8. Kihtir, T, Ivatury, RR, Simon, RJ, Nassoura, Z, Leban, S. Early management of civilian gunshot wounds to the face. J Trauma. 1993;35(4):569-575; discussion 575-577.
9. Bono, CM, Heary, RF. Gunshot wounds to the spine. Spine J. 2004;4(2):230-240.
10. Tung, TC, Tseng, WS, Chen, CT, Lai, JP, Chen, YR. Acute life-threatening injuries in facial fracture patients: a review of 1,025 patients. J Trauma. 2000;49(3):420-424.
11. Ng, M, Saadat, D, Sinha, UK. Managing the emergency airway in Le Fort fractures. J Craniomaxillofac Trauma. 1998;4(4):38-43.
12. Dupanovic, M, Fox, H, Kovac, A. Management of the airway in multi-trauma. Curr Opin Anaesthesiol. 2010;23(2):276-282.
13. Brywczynski, JJ, Barrett, TW, Lyon, JA, Cotton, BA. Management of penetrating neck injury in the emergency department: a structured literature review. Emerg Med J. 2008;25(11):711-715.
14. Perry, M, Morris, C. Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 2: ATLS, maxillofacial injuries and airway management dilemmas. Int J Oral Maxillofac Surg. 2008;37(4):309-320.
15. Dunham, MC, Barraco, RD, Clark, DE, et al. Guidelines for emergency tracheal intubation immediately after traumatic injury. J Trauma. 2003;55(1):162-179.
16. Crosby, ET. Airway management in adults after cervical spine trauma. Anesthesiology. 2006;104(6):1293-1318.
17. Lustenberger, T, Talving, P, Lam, L, et al. Unstable cervical spine fracture after penetrating neck injury: a rare entity in an analysis of 1,069 patients. J Trauma. 2011;70(4):870-872.
18. Isiklar, ZU, Lindsey, RW. Low-velocity civilian gunshot wounds of the spine. Orthopedics. 1997;20(10):967-972.
19. Tourtier, JP, Pierret, C, Charbonnel, A, Auroy, Y. Cervical spine immobilization in the tactical environment. J Trauma. 2011;71(1):265.
20. Thiboutot, F, Nicole, PC, Trépanier, CA, Turgeon, AF, Lessard, MR. Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial. Can J Anesth. 2009;56(6):412-418.
21. Maurin, O, de Regloix, S, Caballé, D, Arvis, A-M, Perrochon, J-C, Tourtier, J-P. Choc neurogénique traumatique. Ann Fr Anesth Reanim. 2013;32(5):361-363.
22. Timmermann, A, Eich, C, Russo, SG, et al. Prehospital airway management: a prospective evaluation of anesthesia trained emergency physicians. Resuscitation. 2006;70(2):179-185.
23. Shimoyama, T, Kaneko, T, Horie, N. Initial management of massive oral bleeding after midfacial fracture. J Trauma. 2003;54(2):332-336;discussion 336.
24. Vriens, MR, Leenen, LPH. Damage control of maxillofacial haemorrhage. Injury Extra. 2008;39(6):225-227.
25. Pusateri, AE, Holcomb, JB, Kheirabadi, BS, Alam, HB, Wade, CE, Ryan, KL. Making sense of the preclinical literature on advanced hemostatic products. J Trauma. 2006;60(3):674-682.


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Maxillofacial Gunshot Wounds

  • Olga Maurin (a1), Stanislas de Régloix (a2), Stéphane Dubourdieu (a1), Hugues Lefort (a1), Stéphane Boizat (a1), Benoit Houze (a1), Jennifer Culoma (a1), Guillaume Burlaton (a1) and Jean-Pierre Tourtier (a1)...


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