Maxillofacial Firearm Injuries: A Protocol for Management in Assiut University Hospital

Aim of Study: To evaluate and classify maxillofacial firearm injuries and to develop a practical protocol to improve patient outcomes. Patients and Results: A total of 179 patients representing about 4.29% of all maxillofacial trauma in the period between 2006 to 2013, with marked increase in the incidence after the Egyptian revolution 25/1/2011, were treated from firearm injuries in Assiut University Hospital. Patients were followed for at least 6 months. Injuries were accidental in seven cases; the remaining injuries resulted from assault. We classified injuries into the following categories: (1) Soft-tissue lacerations with no soft-tissue loss or bone fracture (19 patients); (2) Soft-tissue loss without bone fracture (one patient); (3) Softtissue lacerations with bone fracture (146 patients); (4) Softtissue lacerations with bone loss (11 patients); and (5) Softtissue and bone loss (two patients). Conclusions: Our treatment protocol prioritizes primary emergency care to save the patient’s life and repairing soft tissues to create a bed for second-stage bone reconstruction, if needed. For residual anatomic and esthetic problems, we recommend a later-stage procedure.