Facial reconstruction after gunshot wound injuries in the Department for Maxillofacial Surgery

master's thesis

• Title (croatian): Rekonstrukcija lica nakon prostrijelnih ozljeda na Klinici za kirurgiju lica, čeljusti i usta
• Author: Sebastian Leander Stein
• Mentor: Emil Dediol (mentor)
• Committee member: Emil Dediol (predsjednik povjerenstva)
• Committee member: Ivica Lukšić (član povjerenstva)
• Committee member: ŽELJKO ORIHOVAC (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; Zagreb
• Defense date and country: 2023-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Objective: This study investigated demographic characteristics, clinical features, and surgical approaches in facial reconstruction for patients with gunshot wound (GSW) injuries.

Methods: A retrospective analysis was conducted on selected cases of GSW injuries at University Hospital Dubrava in the Department of Maxillofacial Surgery, from January 2010 to August 2022.

Results: 17 male patients (mean age 41.8 years) underwent facial reconstruction for GSW injuries, predominantly caused by rifles (76.5%) and associated with suicide attempts (70.1%). Mandible fractures (41.2%) were most common, followed by maxillary and zygomatic-orbital fractures (20.6% each). Soft tissue injuries frequently occurred in the lips (41.2%). Surgical approaches varied, involving repositioning, osteosynthesis, bone grafting, and tissue flaps (e.g., RFFF and FFF). Bone grafting was required for vestibuloplasty, primarily in mandibular and maxillary reconstruction. Osteocutaneous flaps were commonly used for mandibular reconstruction, less so for maxillary and palate reconstruction. Zygomatic and orbital fractures were managed with osteosynthesis and titanium mesh. Lip reconstruction had the most versatile approaches. Enucleation of the eyeball was performed in three cases.

Conclusion: This study provides valuable insights into demographic trends, clinical features, and surgical considerations in facial reconstruction following GSW injuries. The predominance of suicide attempts underscores the need for comprehensive mental health support. The distribution of fractures, with mandible fractures being most common, has implications for surgical management. These findings align with existing knowledge and can inform the development of optimized approaches for managing facial gunshot injuries.

Abstract (croatian)

Cilj: Ova studija je istraživala demografske karakteristike, kliničke značajke i kirurške pristupe u rekonstrukciji lica kod pacijenata s ozljedama iz vatrenog oružja (VO).

Metode: Provedena je retrospektivna analiza odabranih slučajeva ozljeda iz VO u Kliničkoj bolnici Dubrava na Klinici za kirurgiju lica, čeljusti i usta od siječnja 2010. do kolovoza 2022. godine.

Rezultati: 17 muških pacijenata (prosječna dob 41,8 godina) podvrgnuto je rekonstrukciji lica zbog ozljeda iz VO, uglavnom uzrokovanih puškama (76,5%) i povezanih sa samoubojstvima (70,1%). Najčešći su bili prijelomi donje čeljusti (41,2%), slijedili su prijelomi gornje čeljusti i zigomatično-orbitalni prijelomi (20,6% svaki). Često su se javljale ozljede mekog tkiva usana (41,2%). Kirurški pristupi su varirali i uključivali su repoziciju-osteosintezu, transplantaciju kosti i slobodne režnjeve (npr. podlaktični režanj i fibularni slobodni režanj). Transplantacija kosti bila je potrebna za vestibuloplastiku, uglavnom kod rekonstrukcije donje čeljusti i gornje čeljusti. Osteokutani režnjevi su često korišteni za rekonstrukciju donje čeljusti, manje za rekonstrukciju gornje čeljusti i nepca. Prijelomi zigomatične kosti i orbite su se liječili osteosintezom i titanskom mrežicom. Rekonstrukcija usana je imala najraznovrsnije pristupe. Enukleacija bulbusa je izvršena u tri slučaja.

Zaključak: Ovo istraživanje pruža vrijedne uvide u demografske trendove, kliničke značajke i kirurške smjernice u rekonstrukciji lica nakon ozljeda iz VO. Prevladavajući pokušaji samoubojstava naglašavaju potrebu za sveobuhvatnom podrškom mentalnom zdravlju. Distribucija prijeloma, s najčešćim prijelomima donje čeljusti, ima implikacije na kirurško liječenje. Ovi rezultati se podudaraju s postojećim saznanjima i mogu pridonijeti razvoju optimiziranih pristupa u liječenju ozljeda lica izazvanih vatrenim oružjem.

• Keywords: facial reconstruction – gunshot wound injuries – self-inflicted gunshot wound injuries – mandible reconstruction
• Keywords (croatian): rekonstrukcija lica – ozljede iz vatrenog oružja – samoozlijeđivanje iz vatrenog oružja – rekonstrukcija donje čeljusti
• Language: english
• URN:NBN: urn:nbn:hr:105:186422
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2023-09-01 12:10:29