Aim: To establish a protocol for effective rehabilitation after maxillofacial injury, with loss of soft tissue, alveolar and basal bone.
Background: Gunshot injuries to the head, neck and face account for 33.57% of overall gunshot injuries from North India, with interpersonal conflicts being the most common reason of all. Cavitation produced by short ranged projectiles cause extensive hard and soft tissue damage with degloving injuries. The complexity in facial skeletal anatomy poses multiple medical and surgical challenges to an operating surgeon, demanding elaborate soft and hard tissue reconstruction. The following case illustrates management of maxillofacial trauma caused by a point blank pistol projectile resulting in a degloving injury to the upper lip, premaxillary and mandibular anterior region.
Case Description: Management of such critical cases commences with basic life support and ends with prosthetic rehabilitation. Hard tissue reconstruction was performed with a cortico-cancellous iliac crest bone graft and soft tissue restoration with microvascular radial artery forearm flap. After complete healing, mandibular cortical and maxillary zygomatic implants were placed. After successful loading with an interim prosthesis, a final prosthesis was planned.
Conclusion: A multidisciplinary approach with an oral and maxillofacial surgeon, ENT surgeon, prosthodontist is indispensable to avoid therapeutic and restorative mishaps.