Kariem, G.Kassan, Ashwin Harkison2022-05-312024-06-042022-05-312024-06-041997https://hdl.handle.net/10566/15792Magister Chirurgiae Dentium (MChD)There appears to be an increase in the use of handguns amongst the civilian population with a resultant increase in the firearm related mortalities in the Cape Town metropolitan area (Lerer et al., 1997). Therefore, the aim of the study was to analyse the demographic data, patterns, management and complications of gunshot injuries to the maxillofacial region. This is a retrospective study of gunshot injuries to the maxillofacial region treated at Groote Schuur Hospital, Cape Town over a 15 year period (1980-1995). A total number of 301 cases were analysed. Maxillofacial gunshot injuries are increasing exponentially over the years with most of these occurring post 1990. The majority of these injuries were due to civilian type low velocity handguns. A smaller percentage were due to intermediate type shotgun injuries which occurred predominantly during periods of political uprising during the early and mid 1980's. The majority of these injuries were purposefully and intentionally inflicted by others. Males within their third decade of life were most often the victims of these gunshot injuries. Most of these patients were of a lower socio-economic status and resided in the traditionally "Black" and "Coloured" residential areas. The wounding effects of these low velocity injuries were characteristic, producing small rounded entrance wounds, causing fragmentation of teeth and comminution of the underlying bone, usually without any exit wounds. Mandibular fractures were more common than the maxillary ones with fracture patterns varying from simple to comminuted type fractures. The comminuted displaced type of fracture pattern, however, were most frequently observed. The most common associated bodily injuries occurred to the head, neck and limb regions. Special investigations included plain film radiographs with more sophisticated investigations, e.g. CT-scans and angiograms being requested where indicated. Necessary airway management was constituted where required and included emergency cricothyroidotomies, oral and nasal endotracheal intubations and elective tracheostomies. The vast majority of the patients, however, required no airway management. The definitive surgical management was initiated by early soft tissue debridement (within 12-24 hrs). There was an equal distribution in both the early and delayed timing of the fracture management. Both the mandibular and maxillary fractures had more open than closed reductions done. Bone continuity defects as a result of the initial injury were usually reconstructed secondarily using free antogenous bone grafts. This, however, comprised only of a smaller number of patients. All the patients received anti-tetanus toxoid on admission and the majority received antibiotic treatment varying from one dose to a five to seven day course. This consisted of either penicillin alone or a combination of penicillin and metronidazole in most cases. The mean hospitalization stay totalled six days. Most recorded complications presented early (within one week) post-injury. The most frequent recorded complications were sepsis, ocular and neurological complications and limitation of mouth opening. The post-operative sepsis rate was high (19%). The common neurological complications consisted of varying degrees of damage to the facial and trigeminal nerves. Blindness was the most common ocular complication observed. Other complications included oro-antral, oro-nasal and parotid fistulae and bony and fibrous ankylosis. These, however, occurred less frequently.enComminutedAvulsive woundsGraftMaxillofacial regionVascularized bone graftMetronidazolePenicillinAnti-tetanusAntogenousToxoidUniversity of the Western Cape