Title: Reconstruction of zygomatic-orbital fracture in pediatric patients victim of physical aggression by a large-caliber firearm projectile
Facial trauma can be considered one of the most devastating aggressions found in trauma centers due to the emotional consequences and the possibility of deformity. This eventuality acquires a much greater danger when produced in children, because regardless of the possible facial scars, they can also affect the centers of growth and development of the facial skeleton, with future repercussions in functional defects that translate as adults with hypoplasias, atrophies and facial disharmonies. For this reason, one must act with great professional security in the face of such emergencies, which require special care regarding diagnosis, classification and treatment, mainly because the face is one of the noblest regions of the body. This study aims to report a case of a pediatric patient victim of a domestic accident by firearm projectiles in which hit the right zygomatic-orbital causing permanent loss of vision. Female patient, 7 years old, accompanied by her mother, went to the emergency hospital in Recife-Pernambuco-Brazil reporting a domestic accident, where the hunting gun accidentally went off between two children. On extraoral clinical examination, the patient presented a perforated-blunt wound in the infected right zygomatic region and characteristic signs of bilateral amaurosis, with ecchymosis and bilateral periorbital edema. On imaging examination, he showed several fragments of firearm projectiles in the posterior region of the left orbital cavity, and with a right zygomatic-orbital fracture affecting the lateral wall and orbit floor, characterized destruction of the midface. The patient underwent, under general anesthesia, procedures for excision of foreign bodies, removal of devitalized tissues and local cleaning, minimizing risks of infection and tissue necrosis. The postoperative period continued in the normal patterns and the patient was rehabilitated with bilateral ocular prosthesis, returning aesthetic and facial symmetry. Understanding the cause, severity and temporal distribution are important factors in the effectiveness of treatment since, facial trauma is a public health concern because of its impact on quality of life.