Trends in maxillofacial injuries in war-time (1914–1986)

doi:10.1016/S0266-4356(89)80001-4

British Journal of Oral and Maxillofacial Surgery

Volume 27, Issue 6, December 1989, Pages 441-450

https://doi.org/10.1016/S0266-4356(89)80001-4 Get rights and content

Summary

In view of evidence of increasing ophthalmic injury in modern warfare we examined available data for evidence of any changes in the incidence of head and neck injuries since 1914. Although data concerning maxillofacial injuries were available for only five of 26 conflicts, we could find no evidence of increasing incidence of head and neck injury. Overall mean incidence of head and neck injury was 16%; greater than expected in terms of random wounding and the proportion of whole body surface area (12%). Data from the Falklands Campaign and Northern Ireland indicate that 3–8% of all casualties sustained middle or lower third fractures of the facial skeleton. Specialists who have expertise in maxillofacial surgery therefore remain an indispensable part of casualty care in modern warfare. Terrorist activity appeared to give rise to more head and neck injury than either rural attack or minor or major conventional war.

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This article deals with the occurrence of health problems due to gunshot wounds to the face among military police officers, in the metropolitan region of Rio de Janeiro, who were submitted to surgery at the Oral and Maxillofacial Surgery and Traumatology Clinic of Hospital Central da Polícia Militar.
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Maxillofacial surgery in wartime Middle-East: Paul Tessier's missions to Iran
2019, Journal of Cranio-Maxillofacial Surgery
Citation Excerpt :
Paul Tessier has contributed to the systematization of the management of severe maxillofacial and craniofacial trauma, and his work on complex fractures and ballistic trauma was especially relevant in the context of war-time facial injuries (Wolfe, 1997, 2012). The epidemiology of wartime maxillofacial injuries has been described by Dobson et al. (1989) and Eiseman (1979): their overall mean incidence was 16%, which is greater than values based on the ratio of the surfaces of the face to the whole body (12%). The incidence of head and neck injuries was 12% for World War I (1914–18), 9% for the Spanish War (1936–39), 4% for World War II (1939–45), 19% for the war in Northern Ireland (1968–98), and 29% for the Falklands War in 1982 (Dobson et al., 1989).
The Iraq–Iran war (1980–88) resulted in numerous maxillofacial injuries. More than 400,000 people were wounded and required specialist care. Paul Tessier, a leading French plastic surgeon and pioneering craniofacial surgeon, was involved in several missions to Iran and operated on a vast cohort of patients with complex war trauma sequelae.
Our study included 322 files relating to patients with war injuries operated on by Paul Tessier in Iran from 1990 to 1993. The files were the property of the Association Française des Chirurgiens de la Face. Relevant epidemiological parameters and data on surgical indications and procedures were collected. Descriptive statistics were used in order to characterize the cohort, and a multivariate logistic model was developed in order to assess factors associated with severe eye injuries within all facial injuries.
Age range at admission was 5–67 years (average: 27.15 ± 6.97). The most common trauma mechanisms were shell fragments (161 patients; 50 %) and bullets (27 patients; 8.38 %). The bone and orbital contents in the upper third of the face were affected in 124 patients (38.50%); 72 patients (22.36%) had trauma of the middle third of the face; and 86 patients (26.71%) had trauma of the lower third. A total of 175 bone grafts were harvested by Tessier: 72 (41.14%) iliac grafts and 94 (53.71%) frontal and/or parietal grafts. Tessier managed 60 orbital fractures (18.63%) and 95 patients with uni- or bilateral enucleations (29.50%). A multivariate logistic model showed that patients injured by shells were 4.04 (1.32; 17.60) more likely (p = 0.03) than patients with gunshot wounds to have had uni- or bilateral enucleation, regardless of age and gender.
Tessier's files provide first-hand information on the injury patterns that resulted from a regional war in the 1980s, and on the reconstruction challenges faced by a country during its post-war recovery period.
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2017, Maxillofacial Surgery, 3rd Edition: Volume 1-2
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2015, British Journal of Oral and Maxillofacial Surgery
Our aim was to identify the pattern and mechanism of facial injuries in Iranian veterans during the Iraq–Iran war and to assess the effectiveness of current protective equipment by retrospectively evaluating 100 Iranian veterans of that war. We randomly included veterans with injuries to various parts of the face, with or without injuries to other organs. None died. We recorded anatomical distribution, incidence, and mechanism of injury as well as injury scores using common references scales. Data are expressed as mean (SD) or number. Fragmentation injuries were the most common (n = 40) followed by blast (n = 37), shock wave (n = 18), and gunshots (n = 5). Thirty-five patients had mandibular fractures with a mean (SD) score of 3.7 (1.4). Fifteen patients had injuries to the upper face and 79 to the midface. Twenty-four patients had facial lacerations more than 10 cm long, with a mean facial injury score of 2.4 (2.0). Nineteen had ocular injuries with a mean (SD) ocular trauma score of 64.9 (12.9). Despite recent developments in protective equipment we have seen no significant reduction in the incidence of facial injuries in battle, which could indicate that we need better facial support equipment and more effective education in its use. However, using protective equipment such as goggles and a mandibular protector is highly recommended.
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Trends in maxillofacial injuries in war-time (1914–1986)

Summary

A comparison of ancient and modern weapons in the effectiveness of producing battle casualties

Journal of the Royal Army Medical Corps

Review of the treatment of facial injuries in the Nigerian Civil War

International Journal of Oral Surgery

Gunshot wounds

Eye injuries and ocular protection in the Lebanon War

Israel Journal of Medical Science

British surgical aid to the Jordan

Annals of the Royal College of Surgeons of England

The Army Medical Service

Civilian battle casualties in South Vietnam

British Journal of Surgery

Casualty care planning

Journal of Trauma

Missile wounds of the head and spine

British Medical Journal

Nature and management of penetrating head injuries during the Civil War in Lebanon

Canadian Journal of Surgery

Medical Department of the US Army

Hostile Action Casualty Statistics

Statistics; Part 2 (Medical and Casualty Statistics U.S. Army; April 1, 1917 to December 31, 1919)

The Falklands War—Army field surgical experience

Annals of the Royal College of Surgeons of England

Missile head wounds in the Korean Campaign

British Journal of Surgery

A field surgical team in Borneo. Sept 1965–March 1966

Journal of the Royal Army Medical Corps