Česká Stomatologie a Praktické Zubní Lékařství (Dec 2010)
Gunshot Injuries of the Middle Facial Floor Accompanied by Damage of Vision
Abstract
Gunshot injuries are even at time of peace one of the possible causes of injury of the middle face region. The severity of these injuries depends on the size of kinetic energy of projectiles or fragments (calculated by the formula:KE=MV2/2,where M is the mass of the projectile and V is the velocity of the bullet) and the type of cavity from the shot and the relationship to the organism (strike, shoot, or bullet hole).We distinguish three areas for each gun channel. The first is inherent channel space with remnants of tissue and foreign bodies, second is the remnants of the damage tissue and finally the foreign body (the bullet) itself. Further from the center is the zone of necrotic tissue (contusion zone) with minor secondary projectiles and furthest from the center of channel is the zone of the molecular shock. Its boundaries are not precisely defined and complicated haemodynamic and metabolic processes are under way and create unfavorable conditions for the use of tissue for primary reconstruction. Therefore, treating these often life-threatening injuries requires reconstructive surgery skills, and it often cooperates with other specialists from different departments. A middle facial gunshot wounds for its localization rarely dispense with damage of eyes or visual pathway. Primary or secondary damage of visual body depends on the topography of injury. Direct devastating injury is more serious, but also secondary damage (e.g. due to bleeding or swelling) can cause extensive damage or total loss of vision.
