Abstract
Prior to World War I, maxillofacial injuries in the United States were relatively uncommon, and most were not very avulsive. This was largely due to
low-velocity bullets and the gentlemanly attitude of ‘‘aim for the heart’’ that
prevailed during the Revolutionary and Civil wars and even in the wellpublicized shootouts of the American West. However, owing to the development of trench warfare and the use of helmets (1), World War I saw a
dramatic increase in the number of maxillofacial injuries. For the first time,
the face was the only exposed portion of the body and therefore became the
obvious target (1,2). Although severe, the projectiles of that day were less
avulsive than the high-velocity missiles developed during the Vietnam War
and thereafter. Consequently, the majority of maxillofacial injuries suffered
during World War I can be classified as fractures. Although World War II,
and later the Korean War, witnessed a similar number, type, and proportion
of maxillofacial injuries as World War I, by this time the advantages of field
resuscitation and transport to local field hospitals for early definitive management had been realized. Along with these advances came the principles
of airway management, wound debridement, fracture stabilization, primary
closure in certain situations, and delayed primary closure in other situations.
These time-honored principles significantly improved the chances for survival and introduced the need for secondary reconstructions (3). Later, during
the Vietnam War, the widespread use of high-velocity missiles led to an
exponential increase in the degree of maxillofacial tissue loss. Surgeons of
that era began treating individuals who had lost large segments of bone
and soft tissue and thus required wider debridements than ever before.
The increased avulsiveness of maxillofacial injuries coupled with the
increased number of survivors afforded by the introduction of helicopter
evacuations created a demand for even more and improved reconstructive
techniques (1).