title: Awful face of the war-impacted smoke bomb capsule in the face and systemic toxicity: reports from the conflict in Syria.
abstract: In this study, a rare kind of injury due to smoke bomb capsule impaction to midface and under the cranial base is presented, and maneuvers to reduce mortality are discussed. Three male patients were presented with impacted smoke bomb capsules into the midface and under the cranial base structures. Midface structures, anterior cranial base, and, in 2 patients, unilateral eye were severely damaged. Two patients died after the initial emergency operations because their lung disease progressed to acute respiratory distress syndrome. One of the patients lived, and soft tissue reconstruction was achieved by using temporal transposition and cheek advancement skin flaps with split-thickness skin graft from donor site. However, craniofacial destruction is important in these patients; a multidisciplinary approach is needed for the treatment of direct smoke bomb injuries because the patients experienced chemical burn and acute trauma. The timing of maxillofacial reconstruction is also a question in these specific patients.
authors.affiliation: From the *Department of Plastic Reconstructive and Aesthetic Surgery, Antakya State Hospital, Hatay, Turkey; †Department of Plastic Reconstructive and Aesthetic Surgery, Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul; Turkey, ‡Department of Plastic Reconstructive and Aesthetic Surgery, Tarsus Medical Park Hospital, Tarsus, Turkey; and §Department of Anesthesia and Reanimation, Antakya State Hospital, Hatay, Turkey.
authors.forename: Bahar
authors.initials: B
authors.lastname: Yilmaz
authors.forename: Nebil
authors.initials: N
authors.lastname: Yeşiloğlu
authors.forename: Remzi
authors.initials: R
authors.lastname: Firincioğullari
authors.forename: Ali
authors.initials: A
authors.lastname: Gökkaya
authors.forename: Rafet
authors.initials: R
authors.lastname: Özbey
authors.forename: Mustafa
authors.initials: M
authors.lastname: Özgür
mesh_terms: D000328:Adult; D001753:Blast Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D054042:Bombs / Q000145:classification*; D002610:Cheek / Q000293:injuries / Q000601:surgery; D002712:Chlorides / Q000633:toxicity; D003646:Debridement; D005131:Eye Injuries / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D005151:Facial Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy*; D011859:Radiography; D019651:Plastic Surgery Procedures; D012128:Respiratory Distress Syndrome / Q000209:etiology / Q000517:prevention & control; D016038:Skin Transplantation; D019291:Skull Base / Q000293:injuries / Q000601:surgery; D012906:Smoke / Q000009:adverse effects*; D013593:Syria; D014857:Warfare; D017967:Zinc Compounds / Q000633:toxicity
chemical_list: D002712:Chlorides; D012906:Smoke; D017967:Zinc Compounds; C016837:zinc chloride