Facial Trauma Caused By Recreational Fireworks

Severe facial soft-tissue injury after firework blast to the face

A 29-year-old male patient presented to the emergency with facial trauma because of recreational fireworks, requiring facial reconstruction surgery.

A 29-year-old man endured facial trauma when he was directly hit by recreational fireworks in the night of January 1st, 2011. The patient was taken to the emergency department and was managed according to the Advanced Trauma Life Support protocol. The patient presented with a compromised airway because of serious bleeding from extensive soft-tissue injury. He was intubated immediately with an endotracheal tube with sedative etomidate and paralytic agent succinylcholine.

The patient was hemodynamically stable, however, had severe soft-tissue injuries to the right side of the face.

The extensive trauma prevented adequate examination of vision and sensibility of the face. Computed tomography (CT) angiography of the face, cranium and neck were performed which showed multiple fractures including:

  • Communtive fracture of the mandible
  • Le Fort 2 fracture
  • Midline fracture of the maxilla
  • Extensive fractures of the walls of the right maxillary sinus; right and left orbital floor
  • Right zygomatic arch fracture
  • Fracture of right temporal bone at the temporomandibular joint

In addition, small hyperdense and spherical bodies which are remnants of explosive powder were also found. An angiography was also performed with findings of an arterial bleeding on the right side of the face. However, there were no signs of intracranial or cervical injuries. Oral and maxillofacial surgery, ophthalmology, and plastic surgery were consulted. The patient was brought to the operation room soon after presentation.

During extensive debridement, the plastic surgeons found large defects of facial musculature in the buccal region. In addition, lesions of the facial nerve and parotid duct were also encountered. The facial artery was clipped intraoperatively. Much of the explosive powder residue was removed. The oral and maxillofacial surgeons approached the fractures of the mandible and maxilla through oral incisions, after the oral endotracheal tube and nasopharyngeal tube were replaced.

The fractures were further reduced and fixated using titanium plates. The parotid duct was finally sutured back into the buccal mucosa and the soft tissue was closed.

Postoperative care

The patient was kept under observation in the intensive care unit. The patient was discharged with no postoperative complication on the 9th day after presentation. However, he had to be readmitted on the 14th day post trauma because he developed a wound dehiscence in the buccal region in association with an orofacial fistula. The defect was closed by the plastic surgeon using a supraclavicular artery island flap 33 days after the incident. Similarly, multiple scar corrections were performed at 16 and 20 months to correct mutilating scars in the face and trismus.

Clinical photograph of patient 1 after the reconstructive surgeries
Clinical photograph of patient 1 after the reconstructive surgeries

The fractures healed without any complications and there was only a slight impact on the patient’s vision. There was persistent drooping of the right corner of the mouth because of facial injury, however, it did not bother the patient.


The Big Bang: Facial Trauma Caused by Recreational Fireworks https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4858422/

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.


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