Oral and Maxillofacial Surgery

, Volume 22, Issue 3, pp 303–307 | Cite as

Mandibular war injuries caused by bullets and shell fragments: a comparative study

  • Auday M. AL-Anee
  • Ahmed Fadhel Al-QuisiEmail author
  • Hassanien A. Al-jumaily
Original Article



Is to compare the patterns, severity, and management of the high- and low-velocity mandibular war injuries managed at Al Shaheed Gazi Al-Hariri Hospital in Baghdad Medical City, Iraq, during a 2-year period.


Forty-one patients with a history of mandibular war injuries treated by our maxillofacial team were reviewed during a period of 2 years (2015–2017). All patients were treated in the Maxillofacial Unit of the Hospital of Specialized Surgeries in Baghdad Medical City.


A 2-year retrospective study evaluated 41 patients with mandibular war injuries with a total of 94 fractures (comminution represents 79.06% of the bullet injuries, while it is only 62.74% with IED injuries). Management of these injuries was varied according to the severity of the injuries and resources available. Close reduction was used in 72.72% of the linear fracture cases, whereas open technique was used in 56.6% of the comminuted fractures.


Bullet injuries were associated with a higher number of mandibular comminuted fractures, in addition to more extensive bone loss. While shell injuries of IED (improvised explosive devices), on the other hand, were associated with higher infection rate and more postoperative complication.


Mandibular fractures War injuries Bullets Shell fragments 


Compliance with ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Peled M, Leiser Y, Emodi O, Krausz A (2012) Treatment protocol for high velocity/high energy gunshot injuries to the face. Craniomaxillofac Trauma Reconstr 5(01):031–040CrossRefGoogle Scholar
  2. 2.
    Perry M, Brown A, Banks P (2015) Fractures of the facial skeleton. WileyGoogle Scholar
  3. 3.
    Cohen MA, Shakenovsky BN, Smith I (1986 Jan 1) Low velocity hand-gun injuries of the maxillofacial region. J Maxillofac Surg 14:26–33CrossRefPubMedGoogle Scholar
  4. 4.
    Breeze J, Tong D, Gibbons A (2017 May 20) Contemporary management of maxillofacial ballistic trauma. Br J Oral Maxillofac SurgGoogle Scholar
  5. 5.
    Ramasamy A, Hill AM, Clasper JC (2009) Improvised explosive devices: patho-physiology, injury profiles and current medical management. J R ArmyMed Corps 155:265–272CrossRefGoogle Scholar
  6. 6.
    Breeze J, Opie N, Monaghan A et al (2009) Isolated orbital wall blowout fractures due to primary blast injury. J R Army Med Corps 155:70.6CrossRefGoogle Scholar
  7. 7.
    Shuker ST (2010) Maxillofacial air-containing cavities, blast implosion injuries, and management. J Oral Maxillofac Surg 68:93–100.5CrossRefPubMedGoogle Scholar
  8. 8.
    Kummoona R (2011) Missile war injuries of the face. J Craniofac Surg 22:2017–2021CrossRefPubMedGoogle Scholar
  9. 9.
    Bataineh AB (1998) Etiology and incidence of maxillofacial fractures in the north of Jordan. Oral Surg Oral Med Oral Pathol Oral Rehabil Radiol Endod 86(1):31–35CrossRefGoogle Scholar
  10. 10.
    Olasoji HO, Tahir A, Arotiba GT (2002) Changing pictures of facial fractures in northern Nigeria. Br J Oral Maxillofac Surg 40(2):140–143CrossRefPubMedGoogle Scholar
  11. 11.
    Tanaka N, Tomitsuka K, Shionoya K, Andou H, Kimijima Y, Tashiro T, Amagasa T (1994) Aetiology of maxillofacial fracture. Br J Oral Maxillofac Surg 32(1):19–23CrossRefPubMedGoogle Scholar
  12. 12.
    Heimdahl A, Nordenram A (1977) The first 100 patients with jaw fractures at the Department of Oral Surgery, dental school. Huddinge Swed Dent J 1(5):177–182PubMedGoogle Scholar
  13. 13.
    Marker P, Nielsen A, Bastian HL (2000) Fractures of the mandibular condyle. Part 2: results of treatment of 348 patients. Br J Oral Maxillofac Surg 38(5):422–426CrossRefPubMedGoogle Scholar
  14. 14.
    Khalil AF (1980) Civilian gunshot injuries to the face and jaws. Br J Oral Surg 18(3):205–211CrossRefPubMedGoogle Scholar
  15. 15.
    Ugboko VI, Owotade FJ, Oginni FO, Odusanya SA (1999) Gunshot injuries of the orofacial region in Nigerian. SADJ 54(9)Google Scholar
  16. 16.
    Singh V, Malkunje L, Mohammad S, Singh N, Dhasmana S, Das SK (2012) The maxillofacial injuries: a study. National journal of maxillofacial surgery 3(2):166–171CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Finn RA (1996) Treatment of comminuted mandibular fractures by closed reduction. J Oral Maxillofac Surg 54(3):320–327CrossRefPubMedGoogle Scholar
  18. 18.
    Bede SY, Ismael WK, Al-Assaf D (2017) Characteristics of mandibular injuries caused by bullets and improvised explosive devices: a comparative study. Int J Oral Maxillofac Surg 46(10):1271–1275CrossRefPubMedGoogle Scholar
  19. 19.
    Ellis E, Muniz O, Anand K (2003) Treatment considerations for comminuted mandibular fractures. J Oral Maxillofac Surg 61(8):861–870CrossRefPubMedGoogle Scholar
  20. 20.
    Holleran RS (ed) (2003) Air and surface patient transport: principles and practice. Mosby IncorporatedGoogle Scholar
  21. 21.
    Kakkar A, Kochhar LK (2000) Missile injuries of face and neck: our experience. Indian J Otolaryngol Head Neck Surg 52(4):334–339PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Oral and Maxillofacial Surgery, College of DentistryUniversity of BaghdadBaghdadIraq
  2. 2.Oral and Maxillofacial Surgeon at Al-Shaheed Gazi AL-Hariri Teaching HospitalMedical CityBaghdadIraq
  3. 3.Oral and Maxillofacial Surgeon at Al-Kindi Teaching HospitalBaghdadIraq

Personalised recommendations