Multi-disciplinary surgical management of ocular and maxillofacial ballistic injury: A case report

INTRODUCTION AND IMPORTANCE: Injury to the maxillofacial region is of great importance due to the highly sensitive area, and the vital structures it carries. Special surgical wounding techniques must be used due to the significant tissue destruction. We report a unique case of a ballistic blast injury in a pregnant woman in a civilian setting. CASE PRESENTATION: A 35-year-old pregnant female, in the third trimester, presented at our hospital after ballistic ocular and maxillofacial injuries. Due to the complex nature of her injury, a multi-disciplinary team consisting of otolaryngologists, neurosurgeons, ophthalmologists, and radiologists was formed to manage the patient. She was managed by performing an evisceration followed by an enucleation and a spherical implant, then underwent mandibulo-maxillary fixation due to a foreign body medial to the left ramus. This initial management plan proved to be effective until two (2) years later, she presented with new onset meningocele and active CSF rhinorrhea and meningitis, due to a left anterior skull base defect. The patient was then managed by reconstructive orbital and ethmoidal roof surgery. In addition, her pregnancy had favorable outcomes after an uneventful delivery. CLINICAL DISCUSSION: Civilian setting injuries are specifically sensitive due to the lack of proper protection, such as in this case. This patient, a pregnant victim of a ballistic blast injury, was managed successfully by a multidisciplinary team through multiple reconstructive surgeries yet presented with a late life-threatening complication. CONCLUSION: Long-term follow-up for such complex cases is recommended due to the possibility of late complications, despite adequate surgical management.