Reconstruction of mandibular “chop-off” defects resulting from gunshot injuries at University Maiduguri Teaching Hospital, Nigeria: A retrospective study

Introduction: Mandibular injuries resulting from high-velocity projectiles often lead to extensive destruction of hard and soft tissues, a phenomenon typically described as “chop-off” wounds. These injuries pose unique challenges in presentation, emergency management, and definitive treatment due to complex anatomy and mechanisms. This study evaluates our clinical experience in managing such injuries at the University of Maiduguri Teaching Hospital (UMTH) Oral and Maxillofacial Surgery Department, which functions within a resource-limited setting. Method: This retrospective study was a case series conducted at UMTH Borno State, during the peak of Boko Haram insurgency from January 2016 to January 2022. The sample included patients with mandibular “chopped off” gunshot injuries, defined as severe lower jaw tissue damage with loss of mandibular bone continuity. Patient files were reviewed for demographic data, wound characteristics, emergency airway management, diagnostic findings, treatment types, follow-up duration, and complications. Data were analyzed using the statistical software SPSS version 20. Results: From January 2016 to January 1, 2022, 117 patients with Gunshot Injuries (GSI) were treated, with 13 sustaining “chop-off” gunshot injuries. The final analysis included the 12 survivors out of 13 initial patients. The mean defect size widest diameter was 4.7 ± 1.1 cm (range 3-6 cm). Seven patients (58.3%) had complete ‘chop-off’ injuries, while five (41.7%) had incomplete injuries. The tongue was involved in two patients (16.6%) with avulsion of the anterior one-third. Five patients (41.7%) required tongue traction for immediate airway management, and seven (58.3%) underwent tracheostomy. Reconstruction plate extrusion with mucosa breakdown occurred in two patients (16.7%), and four (33.3%) had donor site complications. Conclusion: The reconstruction of severe mandibular gunshot injuries is complex. However, regional flaps combined with skeletal stabilization can yield acceptable results in the absence of free tissue transfer.