Facial skin-mucosal biodynamic blast injuries and management

Sabri T Shuker
Journal of Oral and Maxillofacial Surgery 2010, 68 (8): 1818-25

PURPOSE: The blast biodynamic presents maxillofacial injuries of a different type. The analysis of facial skin lacerations and intense flash burns will add new clinical findings that will assist in the early diagnosis of life-threatening airway compromise due to the inhalation of hot gases and toxic fumes. Improvised explosive devices most likely result in blast injuries and severe incendiary situations. Consequently, we require a better understanding of blast pathophysiologic effects, as well as the diagnosis and emergency management of facial soft tissue injuries, which create and provoke new challenges in lifesaving techniques and procedures.

MATERIALS AND METHODS: This article reviews the physics and biophysics of blast facial skin shredding, extensive contusions, lacerations, multiple puncture wounds, partial scalping, flash and thermal burns, thermal inhalation, and toxic fume injuries, as well as detailing the management of blast and thermal wound injuries. In addition, the initial and immediate care of related airway compromise resulting in life-threatening conditions is reviewed.

RESULTS: A new type of conflict-related blast injury is described and evaluated. These explosion wounds result in facial soft tissue injuries, edema of the mucosa of the upper respiratory region, and lung trauma. The understanding of the blast biodynamic injuries associated with thermal burns and inhalation of hot toxic fumes that cause serious respiratory injuries requiring special management should be shared globally with our colleagues.

CONCLUSIONS: Recently, many victims of improvised explosive devices have shown varying degrees of facial injuries in different patterns with or without flash burns. In addition, patients have had intense thermal inhalation that leads to oral-nasal-pharyngeal edema and toxic fume inhalation that may require the management of life-threatening airway compromise. This report will contribute to the lexicon of maxillofacial surgery diagnosis and procedures, including lifesaving airway management, by the appraisal of patients exposed to blast injuries and strong momentary thermal effects on soft tissue wounds.

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