(98) Orbitozygomatic Reconstruction With Rib Allograft Due to Gunshot Wound in an 8-Month-Old

Abstract:
Problem: Gunshot wounds are exceedingly rare in infants and pose complex challenges in both functional and esthetic reconstruction. Pediatric facial trauma requires consideration of durable yet growth-compatible materials as future growth and development of the craniofacial complex must be taken into consideration when treating pediatric facial trauma. There is a dearth of literature regarding pediatric facial gunshot wounds and appropriate reconstructive options.

Methods: Here, we present the case of an 8-month-old female who sustained a gunshot wound to the right face resulting in obliteration of her right zygoma and extensive damage to her right lateral orbital wall and infraorbital rim. She underwent enucleation of her right orbit. She was subsequently reconstructed using a MTF biologics cadaveric rib allograft, secured with resorbable plates and screws to restore the structural components of the zygoma, infraorbital rim, and lateral orbital wall.

Results: The surgical approach aimed to restore facial symmetry, maintain orbital integrity, and allow for future facial growth without compromising function. A virtual planning session preoperatively allowed accurate measurement of the patient’s defect and fabrication of both a defect model and perfected model using a mirror image of the patient’s unaffected side. Postoperatively, the patient exhibited stable structural support in the orbitozygomatic region with satisfactory aesthetic outcomes. Early follow-up demonstrated adequate healing with no signs of graft rejection or infection. Long-term follow-up will be necessary to monitor facial growth and ensure ongoing stable functional and aesthetic results.
Outcomes: Intraoperative CT scan was taken demonstrating satisfactory position of cadaveric rib segments resulting in re-establishment of the architecture of the zygoma and orbital rims. Early postoperative follow-up demonstrated adequate healing and establishment of zygomatic projection with no signs of graft rejection or infection.

Conclusions: Pediatric facial trauma is rare, but poses a complex reconstructive challenge. There is a lack of literature regarding pediatric facial gunshot wounds and appropriate reconstructive options. This case highlights the unique challenges of facial reconstruction in pediatric patients following traumatic injuries such as a gunshot wound and demonstrates the use of rib allograft is a viable option for reconstructing complex craniofacial defects in infants. In early follow-up, it has proven to maintain structural integrity and adaptability to growth. The possibility of future operations once the patient reaches skeletal maturity is understood. Further studies and future follow-up are required to asses long-term outcomes in similar cases.
Preoperative CT 3D ReconstructionIntraoperative placement of rib allograft implants Postoperative 3D Reconstruction