Journal of Craniofacial Surgery
Objective: To present the surgical treatment of a case of Gunshot Wound (GSW) to the face with palatal involvement and Velopharyngeal Insufficiency (VI). A review of the related literature is also presented Methods: Case Report: Literature Review, description of the case, discussion, and conclusion. Results: We present a case of a 33 year old patient who suffered a GSW from a 9mm bullet. The patient was seen at the Emergency Department of the Hospital Gea Gonzalez in Mexico City 11 days after the incident. He presented with an entrance wound penetrating between soft and hard palate and an exit wound on the right malar region. The patient exhibited severe hypernasality and consistent nasal emission. The clinical manifestations of the patient were: nasal regurgitation of food, especially liquids, oral dysphagia, pharyngeal dysphagia and hypernasality secondary to VI. Taking into account that, the minimum speed to pierce the skin is 50 m/s, and to affect the bone 60 m/s. The patient was scheduled for a dual ipsilateral rotational inferior myomucosal flap and superior mucoperiosteal flap with interposition of costal cartilage graft for providing to the closure site. The objective of a levator sling reconstruction is to maximize velar elevation and posterior closure by establishing normal levator muscle relationships. The patient was discharged the following day with liquid diet which was progressed to soft diet after one week. He was followed at the Plastic and Reconstructive Surgery out-patient clinic. The wounds were healed after 15 days. He recovery the proper phonation, swallowing, and breathing, Speech was normal without dysarthria, greatly increasing the capacity of patient´s quality of life. Conclusion: Reconstruction of midfacial traumatic defects is one of the most challenging of the head due to the high impact on functional and aesthetic quality of life, and small margin of error to achieve a good result. It’s treatment depends on the type of weapon used, deforming characteristics of the bullet, kinetic energy, place of impact and state of the patient. Bullet wounds generate a particular injury. Due to their special trauma kinematics in this case our patient required extensive reconstructive surgery with interposition of costal cartilage to recover velopharyngeal stability and adequate phonation. Patients treated with this surgical strategy develop fewer complications such as infection, shrinkage, scarring. As demonstrated by this case report, the result can be satisfactory.
Wagner RM, Cruz DD, Todd IOM, Florez EV, Ysunza PA, Cifuentes MMC, et al. Surgical correction of seconary velopharyngeal insufficiency after gunshot injury. J Craniofac Surg. 2022 Oct;33(7):2303-2304.