Journal of Maxillofacial and Oral Surgery

, Volume 18, Issue 1, pp 124–130 | Cite as

Emergency Treatment of Blast, Shell Fragment and Bullet Injuries to the Central Midface Complex

  • Sabri T. ShukerEmail author
Original Article



Current ballistics and high-energy explosion possess unnoticed, new and significant biophysics and pathophysiology wounding effects that are unique in comparison with civilian trauma. The primary blast wave effects of compressed air due to explosion lead to tattered and crushed eggshell injuries to the upper central midface (UCM). High-energy shell fragments of various shapes and sizes cause extensive destruction and are different from assault rifle’s bullets that cause high energy transfer to the tissue by creating a temporary cavitation.


Twenty-one patients with unquantifiable war injuries were selected. The emergency managment of lifesaving facial war injuries starts with life threatening hemorrahge or air compramise. This article describes immediate management of medial canthal tendon (MCT), intercanthal region and severe nasal war injuries.


The utilized procedure obtained good results compared to the results of cases treated only by applying a classic approach of civilian fractures.


Treatments of UCM injuries are the most difficult since UCM includes the esthetic, physiologic, and anatomical regions of the face. The proposed technique provides immediate excellent stability for soft tissues, bone, and cartilage and is well tolerated in the long term by both the tissue and the patient. Most of the times, victims are treated with limited resources, deficient subspecialty, massive injuries, during mass casualties, and a single surgeon must have to handle all these within a short period of time. UCM injuries are really concerning since this region is the core of facial esthetic and function.


Blast Shrapnel Bullet Upper central midface Nose Orbits Ethmoid 



The author thanks Miss Gillian Elder and staff at the West Bloomfield Library in Michigan for their assistance in this paper.


No any financial interests the authors may have in companies or other entities that have an interest in the information in the Contribution (e.9., National Institutes of Health (NIH); Welcome Trust; Howard Hughes Medical Institute (HHMI); grants, advisory boards, employment, consultancies, contracts, honoraria, royalties, expert testimony, partnerships, or stock ownership in medically related fields).

Compliance with Ethical Standards

Conflict of interest

The author declares that there is no conflict of interest.


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Copyright information

© The Association of Oral and Maxillofacial Surgeons of India 2018

Authors and Affiliations

  1. 1.Formerly Head of Department of Maxillofacial SurgeonBaghdad Medical CityBaghdadIraq
  2. 2.West BloomfieldUSA

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