Principles of care for patients with craniofacial ballistic injuries

Abstract: The mortality rate from firearm injuries in the United States has decreased from 30.3 per 100,000 people in 1990 to 20.6 in 2010, likely because of improvement in treatments. However, the incidence of gunshot wounds continues to increase, including the number of mass shootings, even though the definition of which is still unclear. According to Gun Violence Archives, there were 346 mass shootings in the United States, defined as 4 or more injuries in a single incident, in 2017, with 437 deaths and 1803 injured. This article briefly reviews the ballistics of firearms pertinent for maxillofacial surgeons and summarizes the lessons learned from caring for patients with ballistic injuries to the craniofacial region based on the available peer-reviewed publications and the authors' combined experience of more than six decades. Specifically, we discuss in details the roles of plastic surgeons as a member of the multidisciplinary trauma team in the following three phases: damage control, definitive treatment, and long-term rehabilitation.