Severe combat injuries of the face in the military - there is a solution
Possibilities of maxillofacial surgery in the treatment of facial combat injuries
The war in Ukraine has left its mark on every individual; some have lost their homes, others their loved ones, and some their health permanently. Many soldiers defending the state on the front lines and civilians surviving enemy rocket strikes on their homes have suffered severe injuries to internal organs, limbs, faces etc. The widespread occurrence of such traumas in Ukraine contributes to the development of the medical field and the social perception of the issue. In this article, we aim to focus the reader's attention specifically on post-war facial traumas: loss of an eye, ear, teeth, jaw, nose, and so forth.
Post-war facial traumas can be caused by explosions, gunshot wounds, building collapses, transport accidents, and other military actions. These traumas can lead to various injuries such as fractures of facial bones, loss of parts of the face and organs, burns, scars, muscle, and nerve damage.
Characteristics of combat facial traumas include:
impact on the body's functions: breathing, vision, chewing, and speech, which slows down rehabilitation after injuries overall;
accompanying emotional and psychological difficulties: stress, depression, anxiety, and feelings of isolation and loss. Injured individuals may struggle with self-identification and social adaptation challenges.
Treatment of facial traumas is carried out by specialists in the field of maxillofacial surgery. This is a separate branch of medicine that combines elements of dentistry and surgery, specializing in diagnostic methods and surgical treatment of various purulent-inflammatory processes of the maxillofacial area, new formations of salivary glands, paranasal sinuses, oral cavity, neck, fractures of facial bones, congenital and acquired occlusal defects. Maxillofacial surgery also includes dental implantology and orthopedics, cosmetic and reconstructive correction of facial and cheekbone shape, participation in simultaneous craniofacial surgeries for combined traumas.
Jaw skeleton reconstruction
Jaw skeleton reconstruction after combat facial traumas is an important component of rehabilitation for affected individuals, aimed at replacing the maxillofacial complex to restore the functions of the jaw, teeth, and adjacent tissues after serious traumas resulting from wartime activities.
Features of jaw skeleton reconstruction after combat facial traumas include:
Individualized approach: creating an implant taking into account the specific needs and anatomical features of the affected individual;
Restoration of facial functions and aesthetics;
Psychological support;
Long-term rehabilitation.
Types of implants and prostheses include:
Prostheses and dental implants: they are used to restore lost teeth and improve jaw functions;
Implants for correcting deformities;
Maxillofacial implants;
Implants after traumas or surgeries: they are used to restore the jaw and teeth after traumatic events or surgical interventions.
Exoprosthesis
Exoprosthetics (prosthetics of eyes, ears, nose) requires significant efforts to develop to a proper level in Ukraine, as there are currently significant issues with personnel and state funding. Ukraine has several specialized centers and laboratories involved in the production and installation of exoprosthetics. However, these resources may be insufficient to meet all patient needs. The state actively utilizes modern technologies in the field of exoprosthesis, such as 3D printing, computer modeling, and other innovative approaches. However, access to some advanced technologies is limited, particularly due to lack of funding.
Dental Prosthetics
The presence of healthy teeth is crucial for quick rehabilitation after wartime injuries. Unfortunately, the vast majority of facial traumas in military personnel are accompanied by tooth loss, which makes normal eating impossible and, consequently, rehabilitation difficult. If the trauma is extensive, dental implantation is necessary, which is quite costly. State support programs for financing such implantation are outdated and imperfect, and even if a person receives certain subsidies, they may only count on low-quality implants, which is unacceptable.
According to Natalia Lyutykova, head of the "Likari Geroyam" project, the treatment of facial traumas of military personnel in Ukraine is at a minimum level: "Unfortunately, I must state that the sphere of treatment and rehabilitation of facial traumas in Ukraine still does not receive enough attention, so most of these military personnel do not receive proper assistance and return to their cities, villages, district centers, where they continue their lives within four walls. There are even isolated cases when, according to the decision of the Medical Board, they return to the front and continue to participate in combat actions, having minimal visual acuity or eating rare or blenderized food. It's difficult to provide such nutrition in combat conditions."
Ensuring financial coverage for hospitals' expenses on plates, individualized implants manufactured using 3D printing, and other specific materials for maxillofacial surgery is not carried out in Ukraine. The average cost of an individualized implant is approximately 100,000 UAH. If the state or donors do not cover it, the military personnel themselves are forced to spend such a sum.
Thanks to the establishment and promotion of projects such as "Likari Geroyam" by the "Shidna Zirka" Charitable Foundation, people with severe head and facial injuries receive assistance in the reconstruction and restoration of functions and aesthetics of affected areas. The collaboration of experienced surgeons and bioengineers in Ukraine enables the provision of free medical services to patients, but the reproduction of lost parts of the skull requires the production of individual implants. The charitable foundation has taken responsibility for covering the production costs of implants for each project participant. To achieve this, contributions from donors are accumulated, support is provided during treatment, and the targeted use of funds is monitored.
Recently, the "KOLO" Charitable Foundation joined the project. With their support, funding has already been provided for the treatment of five patients at the Cherkasy hospital and the border hospital in Kyiv. Thanks to the combined efforts of partner charitable organizations and quality information dissemination about the problem, namely the consequences of combat facial injuries and themechanisms of their treatment, more military personnel with such traumas will be able to re ceive assistance and eventually return to normal life.
Experts note that facial injuries are experienced more severely, primarily both morally and physically. This can be explained by several reasons:
limb amputation, although also a serious injury, may be less noticeable externally, especially if it can be concealed by clothing or prosthetics.
acceptance of facial injuries can be more difficult due to their impact on appearance, functions, and emotional state of the individual.
There are various technologies and rehabilitation methods that can help people with amputated limbs regain normal functioning, which is less likely in the case of facial injuries.
Currently, Ukrainian psychologists face a significant challenge in developing methodologies and approaches to implementing an effective rehabilitation process for people with post-war facial traumas. Through the collaboration initiated by the charitable project "Likari Geroyam" and the Center for Medical-Psychological Rehabilitation of ATO zone participants, new approaches and recommendations will be developed for colleagues in Ukraine and abroad regarding the specifics of working with patients who have suffered combat facial injuries.
Post-war facial traumas pose serious challenges for both the affected individuals and medical professionals. However, with an integrated approach to treatment and rehabilitation, as well as the use of innovative methods, significant relief and recovery can be achieved for those who have suffered from these traumas. Maxillofacial surgery is a field of medicine with significant prospects for development in Ukraine, requiring substantial financial efforts from donors and the government.
Useful resources:
NoScar: An initiative that helps Ukrainians get rid of war scars. Helsi and Polytech Ukraine have enlisted the best plastic surgeons from across the country who will perform aesthetic corrections for those affected by military aggression free of charge.
Oral & Maxillofacial Surgery: A team of leading Ukrainian maxillofacial surgeons dealing with the treatment and correction of craniofacial defects, post-traumatic surgery, facial plastic surgery, and implant placement.
IMATEH MEDICAL: A team of professionals in the field of medical 3D printing and modeling, which bases its work on the implementation of advanced developments of digital 3D technologies in biology and medicine, supplying them with necessary standard materials for osteosynthesis and reconstruction.
3D Metal Tech: A high-tech innovative startup of the TAS group of companies. The company, located in Ukraine, specializes in the production of implants adapted to the anatomical characteristics of a specific patient using 3D printing technology on titanium.
Written by
Daria Fysun
PR manager
“KOLO” Charitable Foundation
