Research Article| Volume 27, ISSUE 4, P548-562, April 1969

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The management of missile wounds of the face

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      Treatment of missile wounds of the maxillofacial regions consists of three major phases: primary, intermediate, and reconstructive. Missile wounds cause severe local trauma. The physiologic limits of the tissue to repair may be exceeded by the additional trauma of an open procedure; open procedures are consequently more likely to fail than are closed procedures. The basic tenet of union is strict immobilization for an adequate length of time. It is not uncommon for immobilization to take many months. Fractures within the tooth-bearing portion of the arch can be treated successfully by conventional intermaxillary fixation. Compound, comminuted fractures distal to the remaining teeth require supplemental devices to counteract the upward and medial pull of the muscles of mastication upon the proximal fragment. Intraoral acrylic splints in conjunction with intermaxillary fixation have frequently been used with success to stabilize the fragments. The additional support of external appliances has been required in some cases.
      Reconstruction must await maturation of soft tissue. Reconstructive procedures may require the coordination of several disciplines and may include grafting of bony and/or soft tissue, vestibuloplasty, and prosthetic rehabilitation.
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