JOMS study: Reconstruction of facial gunshot wounds improved by computer-aided surgery

ROSEMONT, Ill. – Using an innovative new protocol employing computer-aided surgery for reconstructing facial gunshot wounds can result in many benefits, including restoration of pre-injury breathing and eating, according to a just published study.

Other benefits of the functional anatomic computer engineered surgery (FACES) protocol include proper jaw position, good facial projection, and improved esthetics of defects of the mouth and nose, according to the study in the March issue of the Journal of Oral and Maxillofacial Surgery – the official journal of the American Association of Oral and Maxillofacial Surgeons (AAOMS).

The FACES protocol involves:

  • Mid-facial/orbital reconstruction
  • Oromandibular (mouth and lower jaw) reconstruction
  • Palatomaxillary (roof of the mouth and upper jaw) reconstruction
  • Internal orbital (eye cavity) reconstruction
  • Soft-tissue reconstruction
  • Dental rehabilitation

Researchers reviewed 10 cases of gunshot wounds to the face treated with virtual surgical planning and computer-aided surgery at Legacy Emanuel Hospital in Portland, Ore. The researchers’ goal with the FACES protocol is to finish as much of the skeletal and soft-tissue reconstruction as possible during initial hospitalization. Early bony reconstruction supports soft tissues, decreases wound contracture (when wound healing can lead to deformity and functional issues), leads to fewer and simpler alterations, takes advantage of the wide surgical access from existing cuts, and reduces problems with follow-up patients, researchers said.

“We have proposed a new protocol for the management of the most complex facial injuries, which we believe optimizes the reconstruction of facial width, projection and contour to produce a functional and reasonably esthetic facial reconstruction,” researchers wrote. “Virtual surgical planning and computer-aided surgery facilitates efficient and accurate primary reconstruction of a complex facial ballistic injury.”

According to the study findings, virtual surgical planning and computer-aided surgery can make early and accurate reconstruction more straightforward.

Most patients were able to return to regular eating and did not need a definitive tracheostomy (a procedure that creates a hole in the windpipe for breathing), and most patients had satisfactory reconstructions based on functions and esthetics, the study states.

“Virtual surgical web meetings and digital 3-dimensional (3D) reconstruction of the defects allows for early planning of procedures without hindrance by patient swelling and hemorrhage,” researchers wrote. “Similarly, navigation, custom guides, plates and screws can facilitate surgery that could otherwise be difficult owing to the lack of visibility and the loss of stable landmarks.”

The authors of “Functional Anatomic Computer Engineered Surgery Protocol for the Management of Self-Inflicted Gunshot Wounds to the Maxillofacial Skeleton” are from Legacy Emanuel Medical Center, The Head and Neck Institute, Portland, Ore.: Baber Khatib, MD, DDS, and Karl Cuddy, MD, DDS, MSc, Fellows, Advanced Craniomaxillofacial Surgery and Trauma; Allen Cheng, MD, DDS, Ashish Patel, MD, DDS, Melissa Amundson, DDS, Tuan Bui, MD, DDS, Eric J. Dierks, MD, DMD, FACS, and R. Bryan Bell, MD, DDS, Attending Oral and Maxillofacial Surgeons, Trauma Service; from the Providence Cancer Center, The Head and Neck Institute, Portland: Felix Sim, BDS, MBBS, MFDS(Eng), Fellow, Head and Neck Oncologic and Microvascular Reconstructive Surgery; and from Oregon Health Sciences University, Portland: Savannah Gelesko, MD, DDS.

The full article can be accessed at www.joms.org/article/S0278-2391(17)31335-6/fulltext.