Multistage composite midface reconstruction after gunshot injury: A case report.

introduction and importanceSevere facial trauma from firearm injuries poses significant reconstructive challenges. This case report highlights the use of advanced reconstructive techniques, including patient-specific 3D implants, radial forearm flaps, costochondral grafts, and prosthodontic rehabilitation, in the restoration of midfacial contour and function following a gunshot-induced deformity. PRESENTATION OF CASE: A 54-year-old male was admitted with a history of a gunshot injury sustained seven months ago to the left orbit and skull base causing severe facial deformities. Physical examination revealed a depressed midface, collapsed nasal bridge, scarred left upper eyelid, displaced right zygoma, missing left maxilla, and an oroantral communication on the right. A multi-staged reconstructive approach was used, including patient-specific 3D implants, a radial forearm flap, a costochondral graft, and prosthodontic rehabilitation, resulting in significant functional and aesthetic improvements. CLINICAL DISCUSSION: This case demonstrates the successful integration of advanced surgical techniques to address severe trauma-induced deformities. Patient-specific 3D planning and implants restored facial contours, while the radial forearm flap provided vital soft tissue coverage. The costochondral graft reconstructed the missing maxilla, and prosthodontic rehabilitation restored oral function. This multi-disciplinary approach enabled the restoration of both form and function.

conclusionThe combination of 3D implants, radial forearm flaps, costochondral grafts, and prosthodontic rehabilitation provides an effective, staged strategy for managing gunshot-induced facial deformities. This case emphasizes the importance of individualized, multi-staged approaches to achieve optimal outcomes in complex trauma. Further refinement of these techniques may improve future surgical protocols.