Over a third of patients with penetrating trauma to the face have significant complications, including intracranial injury, blindness, or infection. 18 Shotgun blasts to the face are especially problematic, and globe injury is common.
The most immediate concern is airway management, which often requires emergency intubation or cricothyroidotomy. Not only is the risk of intracranial injury high, but there is also the possibility of cavernous sinus fistulas. The bullet's path may endanger the great vessels of the neck, and zone III injuries to the carotid are common. Patients at risk require angiography.
Infection is also a concern in patients with gunshot wounds to the face, especially if there is intraoral trajectory. In this situation, administer intravenous antibiotics effective against oral flora.19
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