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ISSN 2007-3178 (Print)
Asociación Mexicana de Cirugía Bucal y Maxilofacial, Colegio Mexicano de Cirugía Bucal y Maxilofacial, A.C.

2025, Number 3

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Rev Mex Cir Bucal Maxilofac 2025; 21 (3)

Ballistic mandibular trauma. Management using different bio-reconstruction strategies. Case report

Soto GS, Amarillas EED

Language: Spanish
References: 17
Page: 134-139
PDF size: 2095.65 Kb.


ABSTRACT

Introduction: gunshot wounds are known for their significant morbidity and mortality, especially when the head and neck region is involved. Mandibular fractures caused by this type of trauma are usually comminuted and, due to their complexity, require special attention. Currently, with advances in technology and reconstruction techniques, these types of fractures can be treated with improved results. Objective: to report a clinical case and present a review of the literature, analyzing management with different bio-reconstructive strategies. Presentation of the clinical case: a 32-year-old male with a comminuted mandibular fracture caused by a firearm projectile. Treatment was carried out in two phases: first, damage limitation was performed, including repositioning of the bone fragments with wire osteosynthesis and dental splinting with resin. Subsequently, elastic traction of the dentoalveolar segments, open reduction and internal fixation of the fracture, and reconstruction with biomaterials were performed. Results: the postoperative period was uneventful. Clinical and radiographic follow-up lasted for two years, maintaining the functional and aesthetic results achieved, with complete bone consolidation and preservation of all teeth. This is noteworthy given that, due to the severity of the injury, characteristic of ballistic trauma, bone and dental compromise is often considerable. Conclusions: stepwise management using different bio-reconstruction strategies preserved the integrity and function of the mandible and teeth.


REFERENCES

  1. Magos-Vázquez FJ, Linkov F, Flores-Mendiola N, González-Moreno MV, Navarro Olivos E, Cardoso-Linares JF et al. Active shooter in emergency departments in Guanajuato State, Mexico. Emerg Med J. 2024; 41 (8): 495-499.

  2. Da Rocha SS, Sales PHDH, Carvalho PHR, Maia RN, Gondim RF, de Menezes Junior JMS et al. Mandibular traumas by gunshot. A systematic review with meta-analysis and algorithm of treatment. Br J Oral Maxillofac Surg. 2021; 59 (3): e99-e108.

  3. Shankar U, Soni H, Komal A. Access leads to success: Management of gunshot injury to maxillofacial region with access osteotomy for bullet retrieval. J Maxillofac Oral Surg. 2022; (4): 1397-1403.

  4. Bourn L, Slovacek C, Lu N, Pocha CC, Wilbert H, Chen C et al. Managing low-velocity mandibular gunshot wounds: an institutional review and the "FLOSS" severity scoring system. J Craniofac Surg. 2025; 36 (2): 518-522.

  5. Grün P, Pfaffeneder-Mantai F, Bandura P, Schneider B, Bandura AS, Turhani D. A cone bean computer tomography investigation of the newly formed mandibular anterior ridge following the treatment of an extended comminuted fracture: a 12-year follow-up. Case Rep Dent. 2024; 2024: 1824016.

  6. Siddiqui SU, Iqbal N, Baig MH, Mehdi H, Mahmood Haider S. Efficacy of open reduction and internal fixation in achieving bony union of comminuted mandibular fractures caused by civilian gunshot injuries. Surgeon. 2020; 18 (4): 214-218.

  7. Finn RA. Treatment of comminuted mandibular fractures by closed reduction. J Oral Maxillofac Surg. 1996; 54 (3): 320-327.

  8. Ellis E 3rd, Muniz O, Anand K. Treatment considerations for comminuted mandibular fractures. J Oral Maxillofac Surg. 2003; 61 (8): 861-870.

  9. Shilo D, Capucha T, Krasovsky A, Blanc O, Emodi O, Haze A et al. Real-time reconstruction of comminuted mandibular fractures using 3D printing. Plast Reconstr Surg Glob Open. 2024; 12 (3): e5645.

  10. Abu Alfaraj TM, Alruwaili BM, Alnasser RF, Alqahtani SH, Alrajhi TN, Alqahtani MA et al. Platelet-Rich Fibrin as a true bone graft substitute: a systematic review and meta-analysis of its osteogenic potential in dental and maxillofacial surgery. Cureus. 2025; 17 (7): e89082.

  11. Desai AP, Sahoo N, Pal AK, Roy Chowdhury SK. Efficacy of platelet-rich plasma in enhancing the osteogenic potential of bone graft in oral and maxillofacial region. J Maxillofac Oral Surg. 2021; 20 (2): 282-295.

  12. Vityadewi N, Prawoto AN, Seswandhana MR, Wahdini SI, Ramli RN, Dachlan I. Treatment of extended comminuted mandibular fractures with infected cutaneous fistule post-ORIF using a reconstruction plate: a case report. Ann Med Surg (Lond). 2022; 80: 104319.

  13. Muddassar M, Arshad R, Rabbani S, Qureshi IS, Khattak IK, Rana Z. Management of gunshot injuries of mandible with open reduction and Internal fixation versus closed reduction and maxillo-mandibular fixation. Cureus. 2020; 12 (4): e7830.

  14. Ma Y, Hao X, Zhao Y. Open reduction and internal fixation strategy for treatment of comminuted mandibular fracture. J Craniofac Surg. 2021; 32 (1): e90-e92.

  15. Arman SS, Shetty A, Ahmed N, Singarapu R, Priya B, Iyengar A. Versatility of titanium mesh in comminuted maxillofacial fractures. A retrospective study. J Maxillofac Oral Surg. 2024; 23 (2): 387-393.

  16. Xu X, Zhu F, Yang C, Xu B, Yuan Z, Zhang W et al. OCCS classification and treatment algorithm for comminuted mandibular fractures based on 109 patients and 11 years experiences: a retrospective study. J Clin Med. 2022; 11 (21): 6301.

  17. Sri Surya TP, Jaggannagari S, Danam RP, Colvenkar S, Alwala AM. Management of comminuted fracture of mandible using titanium mesh. Cureus. 2023; 15 (3): e35799.




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