Comparison of Outcome in Immediate Vs Delayed Management in Patients with Gunshot Injuries to Face, A Prospective Study

Management in Patients with Gunshot Injuries to Face


  • Hafiz Waqas Ahmed Department of Oral and Maxillofacial Surgery, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
  • Riaz Ahmed Warriach Department of Oral and Maxillofacial Surgery, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
  • Muhammad Ghulam Hussain Department of Oral and Maxillofacial Surgery, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
  • Shoaib Zuberi Department of Head and Neck Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
  • Huma Sadaqat Mayo Hospital, King Edward Medical University, Lahore, Pakistan
  • Ayesha Rais Bolan Medical University, Quetta, Pakistan
  • Farheen Shahbaz Department of Public Health, University of the Punjab, Lahore, Pakistan



Gunshot Face Injuries, Immediate Closure, Delayed Closure


Facial injuries due to gunshot often comprise on bone and tissue destruction. The destruction or injury to facial muscle and bone depend on the category of weapon used. Surgical intervention must be done, but the timing for the surgical procedure delayed verses immediate closure surgeries are controversial. Objective: To compare the outcome of immediate and delayed closure of the facial injuries by a gunshot. Methods: A descriptive cross-sectional study consisting of 60 patients getting their treatment in Department of Oral and Maxillofacial Surgery, Mayo hospital, Lahore. Data were analyzed by SPSS version 20.0. Chi-square test was used to compare the results with p-value ≤ 0.05 as significant. Results: Age group on average was 21 to 60 years. Out of these 60 gunshot facial injury patients, 52 (86.7%) were males and 8 (13.3%) were females. Among these, patients managed with immediate closure after gunshot injuries were 44 (73.3%) and 16 (26.7%) were managed with delayed closure. Wound infection and wound dehiscence were compared in both groups. The mean wound defect size was found among patients 3.98 ± 1.30cm. On comparison, statistically significant difference was observed for wound infection and wound dehiscence among both immediate versus delayed groups (p-value < 0.05). Conclusions: In this study, we found that early management is better in terms of lower percentage of wound infection and dehiscence.



Motamedi MH. Management of firearm injuries to the facial skeleton: Outcomes from early primary intervention. Journal of Emergencies, Trauma and Shock. 2011 Apr; 4(2): 212. doi: 10.4103/0974-2700.82208

Vayvada H, Menderes A, Yilmaz M, Mola F, Kzlkaya A, Atabey A. Management of close-range, high-energy shotgun and rifle wounds to the face. Journal of Craniofacial Surgery. 2005 Sep; 16(5): 794-804. doi: 10.1097/01.scs.0000180014.06352.65

Salinas NL and Faulkner JA. Facial trauma in Operation Iraqi Freedom casualties: an outcomes study of patients treated from April 2006 through October 2006. Journal of Craniofacial Surgery. 2010 Jul; 21(4): 967-70. doi: 10.1097/SCS.0b013e3181e17ab5

Peled M, Leiser Y, Emodi O, Krausz A. Treatment protocol for high velocity/high energy gunshot injuries to the face. Craniomaxillofacial trauma & reconstruction. 2012 Mar; 5(1): 31-40. doi: 10.1055/s-0031-1293518

Firat C and Geyik Y. Surgical modalities in gunshot wounds of the face. Journal of Craniofacial Surgery. 2013 Jul; 24(4): 1322-6. doi: 10.1097/SCS.0b013e31829978c3

Kaufman Y, Cole P, Hollier LH. Facial gunshot wounds: trends in management. Craniomaxillofacial Trauma & Reconstruction. 2009 May; 2(2): 85-90. doi: 10.1055/s-0029-1202595

Mannion SJ and Chaloner E. Principles of war surgery. Bmj. 2005 Jun; 330(7506): 1498-500. doi: 10.1136/bmj.330.7506.1498

Vatsyayan A, Adhyapok AK, Debnath SC, Malik K. Reconstruction and rehabilitation of short-range gunshot injury to lower part of face: A systematic approach of three cases. Chinese Journal of Traumatology. 2016 Aug; 19(4): 239-43. doi: 10.1016/j.cjtee.2016.01.016

Thorne CH. Gunshot wounds to the face. Current concepts. Clinic in Plastic Surgery. 1992 Jan; 19(1): 233-44. doi: 10.1016/S0094-1298(20)30906-8

Clark N, Birely B, Manson PN, Slezak S, Vander Kolk C, Robertson B, et al. High-energy ballistic and avulsive facial injuries: classification, patterns, and an algorithm for primary reconstruction. Plastic and Reconstructive Surgery. 1996 Sep; 98(4): 583-601. doi: 10.1097/00006534-199609001-00001

Medel NA, Hamao-Sakamoto A, Zuniga J. Comparing early and late reconstruction of gunshot injuries to the upper and lower face. Journal of Oral and Maxillofacial Surgery. 2014 Sep; 72(9): e228-9. doi: 10.1016/j.joms.2014.06.411

Suominen E and Tukiainen E. Close-range shotgun and rifle injuries to the face. Clinics in Plastic Surgery. 2001 Apr; 28(2): 323-37. doi: 10.1016/S0094-1298(20)32368-3

Gruss JS, Antonyshyn O, Phillips JH. Early definitive bone and soft-tissue reconstruction of major gunshot wounds of the face. Plastic and Reconstructive Surgery. 1991 Mar; 87(3): 436-50. doi: 10.1097/00006534-199103000-00008

Olding M, Winski FV, Aulisi E. Emergency free flap reconstruction of a facial gunshot wound. Annals of Plastic Surgery. 1993 Jul; 31(1): 82-6. doi: 10.1097/00000637-199307000-00018

Vitkus K and Vitkus M. Microsurgical reconstruction of shotgun-blast wounds to the face. Journal of Reconstructive Microsurgery. 1990 Jul; 6(03): 279-86. doi: 10.1055/s-2007-1006831

Hollier L, Grantcharova EP, Kattash M. Facial gunshot wounds: a 4-year experience. Journal of Oral and Maxillofacial Surgery. 2001 Mar; 59(3): 277-82. doi: 10.1053/joms.2001.20989

Bhattacharya V. Management of soft tissue wounds of the face. Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India. 2012 Sep; 45(3): 436. doi: 10.4103/0970-0358.105936

Kretlow JD, McKnight AJ, Izaddoost SA. Facial soft tissue trauma. InSeminars in plastic surgery 2010 Nov; 24(4): 348-356. doi: 10.1055/s-0030-1269764

Mitchener TA and Canham-Chervak M. Oral–maxillofacial injury surveillance in the Department of Defense, 1996–2005. American Journal of Preventive Medicine. 2010 Jan; 38(1): S86-93. doi: 10.1016/j.amepre.2009.10.016

Holmgren EP, Bagheri S, Bell RB, Bobek S, Dierks EJ. Utilization of tracheostomy in craniomaxillofacial trauma at a level-1 trauma center. Journal of Oral and Maxillofacial Surgery. 2007 Oct; 65(10): 2005-10. doi: 10.1016/j.joms.2007.05.019

Ono K, Wada K, Takahara T, ShirotanI T. Indications for Computed Tomography in Patients with Mild Head Injury. Neurologia medico-chirurgica. 2007 Apr; 47(7):291–8. doi: 10.2176/nmc.47.291

Simon B, Letourneau P, Vitorino E, McCall J. Pediatric minor head trauma: indications for computed tomographic scanning revisited. Journal of Trauma and Acute Care Surgery. 2001 Aug; 51(2): 231-8. doi: 10.1097/00005373-200108000-00004

Aveta A and Casati P. Soft tissue injuries of the face: early aesthetic reconstruction in polytrauma patients. Annali Italian Chirurgia. 2008 Nov; 79(6): 415-7.

Karcioglu Ö, Göktas N, Coskun F, Karaduman Sİ, Menderes A. Comparison of tissue adhesive and suturing in the repair of lacerations in the emergency department. European Journal of Emergency Medicine. 2002 Jun; 9(2): 155-8. doi: 10.1097/00063110-200206000-00010




How to Cite

Waqas Ahmed , H. ., Ahmed Warriach, R. ., Ghulam Hussain, M. ., Zuberi, S. ., Sadaqat, H. ., Rais, A. ., & Shahbaz, F. . (2023). Comparison of Outcome in Immediate Vs Delayed Management in Patients with Gunshot Injuries to Face, A Prospective Study: Management in Patients with Gunshot Injuries to Face. Pakistan Journal of Health Sciences, 4(02), 129–133.



Original Article