2025 Poster Presentations
P010: GUNSHOT WOUNDS TO THE FACE IN PEDIATRIC PATIENTS AT A LEVEL ONE TRAUMA CENTER IN THE UNITED STATES: A CASE SERIES
Christopher M Maatouk, MD; Arjav Shah, MD; Hassan A Shah, MD; University of Chicago Medical Center Department of Ophthalmology
Purpose: Although thousands of children are the victims of gunshot wounds (GSW) annually in the United States, the literature regarding the presenting features and outcomes of pediatric patients suffering GSW to the head and face is scarce. The purpose of this study was to identify common presenting features of pediatric patients with GSW to the face as well as clinical outcomes, with particular attention to ocular injuries and outcomes.
Methods: This study represents a case series of all patients seen by oculoplastics at a level one trauma center in the United States after a GSW injury to the face from May 1, 2018 to September 4, 2024. A retrospective chart review was performed on all 9 patients to identify relevant demographic and clinical information. Categorical variables are described using percentages and numerical variables are described using median with interquartile range.
Results: A total of 9 patients were included in this study. The median age was 16.6 (4.7) years and 67% of patients were male. The median Glasgow Coma Score was 13 (8) on presentation. The most common bullet entry site was to the orbit (44%) followed by cheek (33%) with the bullet traversing the midline in 78% of cases. All patients underwent computed tomography imaging of the head and face on presentation. 89% of patients presented with fractures of at least one orbital wall, 56% with midface fractures, and 56% with skull vault or skull base fractures. There were 3 cases each of retrobulbar hemorrhage, open globe injury, optic nerve injury, intra-ocular hemorrhages, and full-thickness eyelid lacerations requiring repair. There were 2 cases of traumatic hyphema and two of facial nerve injury. One patient presented with orbital compartment syndrome requiring lateral canthotomy and cantholysis. 56% of patients also had concomitant intracranial hemorrhage. One patient presented with No Light Perception (NLP) vision in one eye, while one patient had NLP vision in both eyes. 4 patients’ vision could not be assessed on initial examination due to mental status or age. 8/9 (89%) patients underwent surgery to the head or face, with 6/8 (75%) undergoing their first surgery on the date of injury. The most common surgical intervention performed was facial fracture repair (63%) followed by enucleation (38%). At final ophthalmology follow-up, 2 patients were legally blind (less than 20/200 vision) in both eyes. Four patients had NLP vision or had undergone enucleation in at least one eye.
Conclusion: This descriptive study highlights the devastating effect of GSW to the face in the pediatric population, particularly with respect to the eyes and orbits. Given the significant morbidity associated with these injuries, further studies in pediatric populations with larger sample sizes are warranted to identify optimal management patterns and risk factors for poor ocular and systemic outcomes.
Figure 1: Fracture Locations
Figure 2: Ocular Injuries
Figure 3: Bullet wound to the left orbit causing complete destruction of the orbit.
