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The Impact of Blast Implosions and Bullet Injury on Maxillary Air Sinus

Al-Quisi, Ahmed Fadhel, BDS, FIBMS*,†; Al-Anee, Auday M., BDS, FIBMS*,‡; Mohammed, Abbas Sabah, BDS, HDD§

doi: 10.1097/SCS.0000000000005354
Original Article: PDF Only

Background: Successive waves and generations of terrorists attacked the Iraqis in the years following the fall of the regime in Iraq in 2003, after the US invasion of the country under the pretext of weapons of mass destruction. Hence, the Iraqi people enrolled in ongoing war with these armed groups which led to massive casualties due to blasts and missile injuries.

Mechanism of blasts injury can be classified into primary, secondary, tertiary, and quaternary. While bullet injuries can be classified into low and high-energy injuries, the type and severity of the injury will influence the type of management, together with facilities available in the authors’ hospitals.

In this study the authors aim to compare between the effects of blast implosions and penetrating missiles on the maxillofacial air containing cavities, specifically the maxillary sinuses.

Patients and methods: Twenty-eight patients (26 male patients [92.85%] and 2 [7.14%] female patients) with maxillary sinus wall fractures were admitted to the authors’ maxillofacial surgery Department in the Hospital of specialized surgeries/Baghdad Medical city from July 2014 to November 2016.

Results: Seventy-six percent of the total bullet injuries affect the left side of the face, while shell injuries tend to affect the right side of the face by 60% than the left side.

Direct maxillary sinus injuries constitute 76.9% of the injuries caused by bullets, while it constitutes only 40% of shell injuries.

Conclusion: Bullet injuries are associated with more severe comminuted fractures in addition to involvement of multiple neighboring bones and this may lead to extensive bone loss, while postoperative complications and infection are more common with improvised explosive devices injuries.

*Oral and Maxillofacial Department, College of Dentistry, Baghdad University

Al-Kindy Teaching Hospital

Al-Shaheed Gazi Al-Hariri Teaching Hospital, Medical City

§Almaamun Dental Care Center, Baghdad, Iraq.

Address correspondence and reprint requests to Ahmed Fadhel Al-Quisi, BDS, FIBMS, Lecturer in Oral and Maxillofacial Department, College of Dentistry, Baghdad University, Baghdad, Iraq. Oral and Maxillofacial surgeon at Al-Kindy Teaching Hospital, Baghdad, Iraq; E-mail:

Received 23 October, 2018

Accepted 22 December, 2018

The authors report no conflicts of interest.

© 2019 by Mutaz B. Habal, MD.