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Presentation And Management Of Ballistic Mandibular Fractures
Kanad Ghosh, MD1, Shelby Nathan, MD
1, David Grande, MD
1, Hannes Prescher, MD
2, Mélissa Roy, MD
3, Russell Reid, MD, PhD
1.
1University of Chicago Medical Center, Chicago, IL, USA, 2University of Michicago, Ann Arbor, MI, USA, 3McMaster University, Hamilton, ON, Canada.
PURPOSE:Ballistic mandibular fractures can cause devastating injury. However, there is a lack of data regarding their management. Here, we examine the management and outcomes of patients with ballistic mandibular fractures.
METHODS:A retrospective study was conducted reviewing patients with firearm-related mandibular injury presenting to a Level 1 Trauma Center from 2018-2023.
RESULTS: 90 patients were included. The average age was 29.3 ± 13.2 years and 74 (82.2%) were male. 82 (91.1%) presented post-assault, 6 (6.7%) after self-inflicted injury, and 2 (2.2%) after accidental injury. Body fractures were the most common (40.0%) followed by ramus (25.6%) and angle (13.3%) fractures. 47 patients (52.2%) also had non-facial injuries. On presentation, 68 patients (75.6%) were intubated; 34 (37.8%) of them later required tracheostomy. 40 patients (44.4%) presented with significant bleeding; 14 (15.6%) were taken to the operating room and 8 (8.9%) were taken for embolization. 67 patients (74.4%) required surgical repair; 48 of them (71.6%) were repaired with internal fixation, 16 (23.9%) required bone grafts, 45 (67.2%) were placed in maxillomandibular fixation, and 3 (3.3%) required microvascular reconstruction. 14 patients (15.6%) had complications post-operatively; 2 (2.2%) had wound healing complications, 6 (6.7%) had infection, 3 (3.3%) had exposed hardware, 3 (3.3%) had malunion, and 1 (1.1%) had palatal fistula and carotid-cavernous fistula, respectively. 12 (13.3%) required surgery for complications. Neurologic complications led to mortality in 6 (6.7%) patients.
CONCLUSION: Ballistic mandible fractures present a unique challenge. Our study is one of the few to examine management and complications of ballistic mandibular trauma.
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