INITIAL EVALUATION AND MANAGEMENT OF GUNSHOT WOUNDS TO THE FACE

Background: The literature on early management of gunshot wounds (GSWs ) to the face is scant, with only six series reported in the English-l anguage literature in the last 12 years. In the current study, we pres ent a large series from a busy trauma center in an effort to identify early diagnostic and therapeutic problems and recommend management gui delines. Methods: Retrospective analysis was done for all GSWs of the face during a 4-year period. Data were obtained from the Trauma Regist ry and Trauma Patient Summary hard copies. Results: During the study p eriod, there were 4,139 admissions for GSWs, with 247 (6%) involving t he face. An associated brain trauma was found in 42 patients (17,0%), and cervical spine fracture was found in 20 patients (8.1%) with GSWs to the face. In 43 patients (17,4%), there was a need for emergency ai rway control because of local hematoma or edema. Angiography was perfo rmed in 70 patients (28.3%) for evaluation of a large hematoma or cont inuous bleeding, and in 10 of these patients successful embolization o f bleeders was achieved. No patient required operative control of blee ding from facial structures, Overall, only 96 patients (38.9%) underwe nt operation for soft-tissue repair or reduction of facial bone fractu res. There were 36 deaths (14.5%) from severe brain injury or severe b leeding from associated chest or abdominal injuries, No death occurred in isolated GSWs to the face. Conclusion: Most civilian GSWs can safe ly be managed nonoperatively. Airway control is required in a signific ant number of patients and should be established very early. Bleeding from the face is best controlled angiographically, The brain and cervi cal spine should be aggressively assessed radiologically because of th e high incidence of associated trauma.