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A Decadal Review of Reconstruction of Maxillofacial Gunshot Injuries and the Trajectory Forward

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Marcus Hwang
Marcus Hwang
Marcus Hwang
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Srinivasa Rama Chandra at University of Nebraska Medical Center
Srinivasa Rama Chandra
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Purpose of Review Over the past decade, firearm-related injuries and fatalities have become more prevalent with head and neck injuries the most common in suicide-related attempts. This is accompanied by significant mortality and morbidity with devastating burden on healthcare systems. This review is a comprehensive examination of facial gunshot injuries over the past decade, integrating epidemiological trends, biomechanical insights, historical and contemporary reconstructive methods, and a forward-looking exploration of the future trajectory in managing such injuries. Recent Findings Firearm-related injuries and hospital admissions are demanding to the healthcare system with the total cost of 493.2billionintheUnitedStatesaloneinmanagementoffirearmrelatedinjuriesandmortalities[1].RecenttrendsaftertheCOVIDpandemichighlightanincreasingnumberofU.S.citizensowningfirearms[2].Managementofsuchcomplexheadandinjuriesalonecanreachashighas493.2 billion in the United States alone in management of firearm related injuries and mortalities [1]. Recent trends after the COVID pandemic highlight an increasing number of U.S. citizens owning firearms [2]. Management of such complex head and injuries alone can reach as high as 293,000 for a single patient [3, 4].
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Vol.:(0123456789)
Current Surgery Reports (2025) 13:8
https://doi.org/10.1007/s40137-024-00441-9
A Decadal Review ofReconstruction ofMaxillofacial Gunshot Injuries
andtheTrajectory Forward
MarcusHwang1 · SrinivasaRamaChandra2
Accepted: 9 December 2024
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024
Abstract
Purpose of Review Over the past decade, firearm-related injuries and fatalities have become more prevalent with head and
neck injuries the most common in suicide-related attempts. This is accompanied by significant mortality and morbidity with
devastating burden on healthcare systems. This review is a comprehensive examination of facial gunshot injuries over the
past decade, integrating epidemiological trends, biomechanical insights, historical and contemporary reconstructive methods,
and a forward-looking exploration of the future trajectory in managing such injuries.
Recent Findings Firearm-related injuries and hospital admissions are demanding to the healthcare system with the total cost
of $493.2billion in the United States alone in management of firearm related injuries and mortalities [1]. Recent trends after
the COVID pandemic highlight an increasing number of U.S. citizens owning firearms [2]. Management of such complex
head and injuries alone can reach as high as $293,000 for a single patient [3, 4].
Keywords Maxillofacial injuries· Gunshot wounds· Ballistic injuries· Head and neck reconstruction· Facial implants,
firearm injuries
Introduction
Incidence of firearm related injuries is considered a public
health issue as the incidence over the past decade paral-
lels all US combat casualties during the decade of the two
major World Wars [5, 6]. Among those of 1 to 24 years
of age, firearms remain as the leading cause of death [7].
Pediatric related firearm fatalities have also increased 67%
over the past decade [6]. In recent years, the paradigm on
surgical reconstruction has been influenced by advances in
virtual surgical planning, 3D printing, and biologics [8].
Since their introduction and widespread availability, their
use has been irreplaceable in reconstruction of oncologic
defects or trauma-related injuries. Surgical reconstruction of
maxillofacial gunshot injuries also shared similar benefits,
but the nature of ballistic injuries poses a unique challenge
in maxillofacial reconstruction. Specifically, high-velocity
projectiles deliver forces propagated through small surface
areas causing tremendous transfer of energy. Subsequent
projectile fragmentation also contributes to collateral dam-
age. These transmitted forces lead to delayed presentation
of tissue necrosis around the periphery of damage. Ballis-
tic injuries, therefore, present with considerable soft tissue
loss and severely comminuted osseous damage, therefore
the standard delayed-reconstructive approach taken on by
many surgeons [9]. The simplest definition in management
of such injuries belong to Pirogov (1941): “. to convert a
crushed wound into an incised wound” [10]. Later this was
expanded by another prolific surgeon: “contused, crushed,
dead, and dying wound edges must be excised to the point of
active capillary bleeding then the wound becomes an incised
wound” [10].
As reconstructive surgeons, it is imperative to delve
into this dynamic landscape to offer not only surgical solu-
tions but restorative form and function. The technological
advances of the times have set a new standard for surgical
reconstruction. As we embark on this decadal review, our
aim is to provide a current epidemiological account of gun-
shot injuries, brief explanation of the mechanics underlying
ballistic injuries, and a comprehensive review of the changes
in surgical management. We hope to provide brief insight
* Marcus Hwang
hwangji@ohsu.edu; marcushwang.dds.md@gmail.com
1 Oral andMaxillofacial Surgery Resident, Oregon Health &
Science University, Portland, OR, UnitedStates
2 Department ofOral andMaxillofacial Surgery, Oregon
Health & Science University, Portland, OR, UnitedStates
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