title: Low-velocity gunshot wounds to the maxillofacial complex.
abstract: 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.
mesh_terms: D000402:Airway Obstruction / Q000209:etiology; D001930:Brain Injuries / Q000601:surgery; D002339:Carotid Arteries / Q000601:surgery; D020212:Carotid Artery Injuries; D003646:Debridement; D006801:Humans; D007710:Klebsiella Infections / Q000209:etiology; D008337:Mandibular Fractures / Q000601:surgery; D008446:Maxillofacial Injuries / Q000150:complications / Q000601:surgery*; D008581:Meningitis / Q000209:etiology; D014140:Tracheotomy; D014946:Wound Infection / Q000209:etiology; D014948:Wounds, Gunshot / Q000150:complications / Q000601:surgery*