Characteristics of Ballistic and Blast Injuries
Ballistic injury patterns to the craniomaxillofacial region present a unique, and challenging, dilemma for the facial trauma surgeon. The tissue disruption associated with ballistic injury to the head and neck region can be daunting, and the identification of normal anatomic planes, potentially lost within bleeding, destroyed soft and hard tissues, can challenge the skills of even the most experienced facial trauma specialist. While classically considered to be under the purview of the military trauma surgeon, ballistic and blast injuries are routinely treated by the civilian surgeon due to the incidence of intentional and unintentional firearm injuries and industrial accidents. Unfortunately, as evidenced by the recent surge of terrorist attacks in locales such as Paris, France and Orlando, Florida, the civilian craniomaxillofacial trauma surgeon must have not only a working knowledge of the management of ballistic wounds to the craniofacial region, but also an understanding of the staging and timing of the treatment of these injuries. A basic understanding of the definitions and characteristic clinical findings of ballistic and blast wounds should be an important tool in the armamentarium of the practicing craniomaxillofacial trauma surgeon.
