Penetrating Midface Trauma

Penetrating Midface Trauma: A Case Report, Review of the Literature, and a Diagnostic and Management Protocol:



Publication date: Available online 14 October 2020

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Eric Holmgren, Derrek Schartz, Nithya Puttige Ramesh, Kimutai Sylvester, Clifford Eskey




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Journal of Oral and Maxillofacial Surgery
Available online 14 October 2020
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Craniomaxillofacial traumaPenetrating Midface Trauma: A Case Report, Review of the Literature, and a Diagnostic and Management Protocol
Author links open overlay panelEricHolmgrenDMD, MD∗DerrekSchartzMD†Nithya PuttigeRameshBDS, MPH‡KimutaiSylvesterMD§CliffordEskeyMD, PhD‖Show more
https://doi.org/10.1016/j.joms.2020.09.031Get rights and content


Purpose

Penetrating facial trauma is an uncommon injury, but patients who present with these dramatic situations require special consideration. We describe the case of a young man who had been shot with an arrow that deeply penetrated his midface as well as report the results of a literature review of penetrating midface injuries. The information gathered was used to create a diagnostic protocol for patients who sustain such injuries.

Methods

A PubMed search up to October 2019 using several key phrases was performed, and 623 unique articles were evaluated. Excluding firearm injuries to the midface, there were 57 unique cases that involved penetrating midface injuries. Clinical and imaging data were compiled and evaluated with descriptive statistical analysis.

Results

The average patient age was 27 years, with a male predilection. The most common reported etiology was accidental trauma (54%), and a knife was the most common weapon of injury (30%). The most common (32%) specific location of trauma was within the orbital region, including the canthus or the eyelid. In all cases where the patient had not died immediately, surgery was used to remove the penetrating object. We found that computed tomography was the most commonly obtained imaging study (39% of cases). Radiographs were the sole imaging in 28% of cases, with angiography (16%) and magnetic resonance imaging (10%) used less frequently in management. In 28% of cases, deep structures, such as the carotid artery, sphenoid sinus, or skull base, were involved in the injury. In 25% of the cases, there was injury to the central nervous system. Death occurred in 8.8% of cases. Postoperative complications occurred in at least 21% of cases. Statistical analysis also revealed a significant correlation between antibiotic use and full recovery. Penetration of the object posterior to the maxillary sinus was correlated with incomplete recovery or death.

Conclusions

Based on all case reports collected, a Dartmouth Penetrating Midface Protocol was developed to aid the practitioner who may happen to be responsible for these dramatic life-threatening injuries. The Dartmouth Penetrating Midface Protocol is based on the type of imaging available at the treating facility, the neurologic and hemodynamic stability of the patient, and the depth of penetration beyond the posterior wall of the maxillary sinus.



Conflict of Interest Disclosures: None of the authors have any relevant financial relationship(s) with a commercial interest.View full text
© 2020 Published by Elsevier Inc. on behalf of the American Association of Oral and Maxillofacial Surgeons

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