Therapeutic management of a severe maxillofacial defect after landmine fragmentation

Abstract

Reconstruction of severe maxillofacial defects caused by shrapnel represents a complex challenge in the maxillofacial area. We report the case of a 42-year-old military patient who suffered extensive soft tissue and bone defects following an injury from fragmentation of an antipersonnel mine in the Ukrainian war. He presented a shrapnel wound with massive soft tissue damage in the midface region and fractures with multiple fragments in the maxilla and orbital walls, including loss of soft tissue, bone and eyeball. A two-stage surgical approach was performed. In the initial prehospital phase, surgical debridement with cavity cleaning and removal of foreign bodies and nonviable tissue was performed. In a second phase after evacuation to the Military Medical Clinic, a 3D model was created, and a custom-made titanium mesh was made to reconstruct the periorbital and maxillary area. Subsequently, residual correction of a skin defect was required using a frontal pedicle flap. The result at 6 months was satisfactory. This case demonstrates the importance of a multidisciplinary and stepwise approach to optimize functional and aesthetic outcomes in complex maxillofacial reconstructions in the military setting.