310 J. Cranio-Max.-Fac.Surg. 18 (1990) J. Cranio-Max.-Fac. Surg. 18 (1990) 310 - 314 © Georg Thieme VerlagStuttgart - New York Reconstruction of Gunshot Wounds of the Mandible 128 Cases Treated by Autogenous Iliae Crest Bone Grafts Abbas A. Y. Taher Clinic of Oral and Maxillofacial Surgery (Head: A. A. Y. Taher,B.D.S., D.D.S., O.M.F.S.),BaqietUllaUniversity Hospital, Tehran,Ira n Submitted 19.4. 89; accepted 30.4.90 Summary 128 cases of mandibular reconstruction for defects due to gunshot injuries were treated by various types of au- togenous iliac crest bone grafts during a period of 4years and six months. The survival rate of these grafts was 98.43 per cent. Key words Gunshot wounds - Mandible - Iliac crest grafts - Techniques - Follow-up - Complications Introduction Gunshot wounds, because of the extensive damage to bone and soft tissues, present a major challenge to the skill of the maxillofacial surgeon and their treatment may extend over a period of many years. The severity of the injury depends upon several factors, but is primarily due to the kinetic en- ergy (KE) imparted at the time of impact. According to the formula KE = 1/2 Mass x Velocity 2 it will be evident that terminal velocity is more important than mass in determin- ing the energy dispersed at the point of impact (Rowe and Williams, 1985), (Table 1). Material and Methods 128 patients required bone grafting out of a total of 760 cases of mandibular injury (16.82 per cent). All the patients were males, with ages ranging from 16 to 55 years, the ma- jority of whom (42.96 per cent) were in the age group of 15 to 20 years (Table 2). The numbers requiring bone grafting increased each year reaching a peak during the summer months of 1988. All the patients were treated either in the Clinic of Oral and Maxillofacial Surgery, Najmeia or the Baqiet U|la General Hospital, Tehran from 1 s~March, 1984 to 30 th September, 1988. The time of reconstruction after injury varied from 3 months to 12 months and depended upon the following factors: 1) Severity of the injury. 2) General condition and presence of associated injuries. 3) Presence of soft tissue defects. 4) Presence of bone fragments and broken teeth in the area. 5) The patient's understanding of his injury and desire for reconstruction (Fig. 1). Patients were referred from three sources: a)Directly from the site of the injury after emergency treat- ment (70 cases). b) From other hospitals (40 cases). c) Non-urgent cases from the injured Services Patients Cen- tre, Tehran (18 cases). Defects ranged in length from 3 cm. to 15 cm. and were re- stored by the following types of graft (Tables 3, 4): A) Full-thickness iliac crest bone graft split into two pieces which were fixed together to provide adequate length for the longer graft. B) Cortico-cancellous grafts. C) Cancellous block. D) Cancellous particulate (chip) grafts in a titanium mesh support. This type of graft was taken from the iliac bone after a "trap-door" was elevated from the lateral aspect. E) Half-thickness iliac crest cortico-cancellous grafts were used for condylar reconstruction which enabled a rounded configuration to be achieved. Table 1 Types of missiles No. % Solid missiles (bullets, anti-tank 85 66.4 shells) Fragmentation missiles 18 14.06 Land mines, anti-personnel mines 12 9.37 Blast and crush injuries 5 3.9 Others 8 6.25 Total 128 100.00 Table 2 Age distribution 15 - 20 55 42.96 21 - 25 30 23.43 26 - 30 18 14.06 31 - 35 11 8.59 36 - 40 6 4.68 41 - 45 3 2.34 46 - 50 2 1.56 51 - 55 3 2.34 'This paper was presented in the 33 re World Congress of Surgeryin Total 128 100.00 Toronto, Canada, September 10-16, 1989.