In peacetime, they are rare (hunting, accidents, etc.). According to the experience of the Great Patriotic War of 1941-1945, isolated injuries of the maxillofacial region accounted for 3.5-4% of their total number, 97.1% were gunshot. These indicators depend on the conditions of combat operations.
Etiology and pathogenesis of gunshot wounds to the face
Gunshot wounds are inflicted due to the kinetic energy of injuring shells (shot, buckshot, bullets, fragments of artillery shells, aircraft bombs and torpedoes, artillery and engineering mines, rockets, grenades, etc.). New weapons with high kinetic energy and flight speed have significantly changed the nature of gunshot injuries. They are characterized by small dimensions of the inlet, large destruction along the wound channel and at the outlet. The mechanism of action of a fire projectile in the human body during the formation of a wound is determined according to the laws of wound ballistics, the study of which showed that the degree of destruction of the organs of the maxillofacial region depends on their elasticity, strength and histological structure. Providing great resistance, bones and teeth repay a significant part of the kinetic energy of the projectile and are destroyed with an “explosive” effect. Their fragments, turning into “secondary” shells, further destroy the surrounding tissue. As a result, extensive ruptures and fragmentation of tissues occur, up to traumatic amputation of a part of the face (lower jaw, tongue, middle part of the face with a nose and even eyeballs). Complicated surgical intervention with a deep audit is required not only in the area of destroyed tissues and organs, but also in the remaining neighboring areas, subjected to shock and tremor of tremendous force with an “explosive” effect.
Clinic of gunshot wounds to the face
The clinical picture is extremely diverse. When examining the wounded, it is necessary to establish the following: the type of wounding weapon; the number of injuries (single, multiple); the nature of the wound and the direction of the wound channel (blind, through. tangent, traumatic amputation); the direction of the wound channel (segmental, contour, diametric); localization and nature of destruction of soft tissues; localization and nature of bone destruction; the nature of the wound (isolated, combined, multidimensional ); penetrating or not penetrating into the oral cavity, nose, sinuses, pharynx, larynx, esophagus, trachea or several cavities at once; the nature of damage to organs in the oral cavity (teeth, tongue, soft and hard palate, salivary glands, etc.); damage to adjacent areas (temporomandibular joint, organs of vision, hearing, neck, skull, brain, spine, etc.); damage to the limbs, chest, abdomen, etc .; severity of injury or damage (mild, moderate, severe, terminal). It is necessary to take into account the features of facial trauma: disfigurement; a mismatch between the appearance of the wound and the severity of the wound; the presence of teeth as secondary shells and sources of infection of wounds; the proximity of vital organs (respiration, vision, hearing, brain, neck organs), which makes this group of victims especially difficult due to the threat of asphyxiation, bleeding, shock and other complications; the need for special care and nutrition; emotional and mental disorders. The diagnosis is made on the basis of the described symptoms. It is necessary to approach in an integrated and strictly individual manner, taking into account all the above factors.