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ITALIAN JOURNAL OF MAXILLOFACIAL SURGERY
A Journal on Maxillofacial Surgery
Official Journal of the Italian Society of Maxillofacial Surgery
Italian Journal of Maxillofacial Surgery 2010 April;21(1):27-34
Unusual localization of bullets in the face (deep fossae): when and whether to operate. Personal experience
Cristofaro M. G., Giudice A., Zinno G., Giudice M.
Division of Maxillofacial Surgery, Department of Clinical and Experimental Medicine, Faculty of Medicine, Germaneto di Catanzaro, Catanzaro, Italy
Aim. Facial traumas caused by gunshot wounds are even more common because of the increase of organized crime. Facial gunshots can cause an important destruction of cranio-facial skeleton with an involvement of soft tissue and sometimes, of the deep fossae. The authors’ aim is to present the management of five cases with symptomatic bullets, all located in deep fossae of the face.
Methods. From January 2003 to June 2009 a total of 15 patients with gunshot wounds have been operated; in five of them there was an involvement of the deep fossae: pterygopalatine fossa; temporal fossa; infratemporal fossa; sphenopalatine fossa, lateralpharyngeal space and pterygopalatine and pterygomandibular fossae (triple localization on the same patient). The surgical treatment consisted on the bullet removal, stabilization of the fractured bone fragments (with titanium screws and plates), and reparation of the soft tissue with an immediate reconstruction, in one surgery intervention.
Results. All patients’ clinical follow-up visits were performed at 1-3-6 months, 1-2 years while the instrumental follow-up (orthopantomography, computed tomography) was performed at six months and at one year. Results were satisfactory for resolution of most of the symptoms and complications.
Conclusion. The surgical treatment of facial gunshot wounds depends on the damage reported; our protocol provides a surgical treatment simultaneously on the soft and bone tissues. When a large loss of tissue occurs, primary stabilization of the skeleton is indicated. The bullets located in the deep fossae must be removed only if they are symptomatic or located near dangerous areas (big veins, arteries, nerves, first airways).