ORIGINAL ARTICLE   

European Journal of Oral and Maxillofacial Surgery 2022 April;6(1):17-23

DOI: 10.23736/S2532-3466.21.00259-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Description of oral and maxillofacial ballistic missile injuries based on tactics and terrain of conflict in Yemen civil war: account from a level 1 trauma center in Najran, Saudi Arabia

John S. DANIELS ¹, Ibrahim ALBAKRY ¹, Ramat O. BRAIMAH ² ✉, Mohammed I. SAMARA ¹, Rabea A. ALBALASI ³, Farzana BEGUM ¹, Mana A. AL-KALIB ¹, Fawaz M. AL-ZULAYQ ¹

¹ Section of Surgery, Department of Maxillofacial Surgery, King Khalid Hospital, Najran, Saudi Arabia; ² Section of Surgery, Department of Oral and Maxillofacial Surgery, Specialty Regional Dental Center, Najran, Saudi Arabia; ³ Section of Surgery, Department of Maxillofacial Surgery, Sharourah General Hospital, Sharourah, Saudi Arabia

BACKGROUND: Information describing maxillofacial ballistic injuries based on tactics and terrain of conflict is scarce hence the rationale for the current study.
METHODS: Combatant Yemeni patients, transported across the border from Yemen into Najran, Saudi Arabia, were recruited into the study. Demographics, etiology of injury (gunshot or bomb blast) were documented. Intraoral or extraoral bullet entry were recorded in gunshot victims, while landmines, landmines-related motor vehicular accident (LR-MVA) and improvised explosive devices (IED’s) were noted in the bomb blast victims. The treatment protocol adopted was also recorded.
RESULTS: A total of 408 victims with maxillofacial injuries were seen (173 [42.4%] gunshots and 235 [57.6%] bomb blasts injuries). Age ranges from 14-56 years and mean±SD (26.79±7.3) years. Fifty-three (13%) gunshot victims reported sniper tactics with intraoral bullet entry while battlefield gunshot injuries were reported in 120 (29.4%) victims with extraoral bullet entry. Explosion from landmines was responsible most of the injuries among the bomb blast victims (118 (28.9%) patients), while 46 (11.3%) victims suffered injuries resulting from LR-MVA. Damage control surgery (DCS) in 162 (39.7%) victims and aggressive surgery (AS) in 106 (26.0%) hemodynamically stable patients were adopted as management strategy. Wound exploration combined with ORIF of fractures was treatment used in 268 (65.7%) patients.
CONCLUSIONS: Victims with intraoral entry of bullets admitted the use of sniper tactics while in the bomb blast victims, landmine, LR-MVA and IED’s mechanisms were reported. DCS and AS constituted the main treatment protocol adopted in the victims.

KEY WORDS: Wounds, gunshot; Maxillofacial injuries; Surgical procedures, operative