Survival chance with extreme facial wound

Hello Everyone,

I’m currently reading a book about the battle for Iwo Jima. After reading hundreds of books on World War II nothing much makes me dwell on something, however I read something tonight that has given me the willies.

A Marine was recounting how he was under mortar attack and he dived into a shell hole. Upon jumping into the crater he landed on top of another Maine. He said the Maine started to attack him, trying to choke him. He yelled “Marine, Marine!” but continued to be attacked. He said he managed to lift the soldier’s helmet and recoiled from the sight. He said the Marine in the hole “had no face”. He was able to see the man’s sinus cavity, eye sockets and bone, but said there was very little blood.

He didn’t say what eventually happened to this Marine, but is it possible to survive long term without a face? Is there anything doctors could have done back in 1945 to help this man? Is there even anything that could be done today? I realize there have been face transplants, but I would assume that most of the facial bones were still intact when those surgeries were performed.

Apparently a piece of shrapnel had cleanly sliced off this Marines face, if it was me I would have preferred if the man who jumped in my hole would take mercy on me and put me out of my misery. This is one of the rare times something I’ve read had a actually horrified me.

You absolutely can survive any number of horrible facial wounds. There is nothing about the face that is integral to life. What generally causes death in this type of wound is, initially, loss of airway (blocked by the trauma), secondarily, some sort injury to the brain,(occurring at the same time as the trauma), or an infection. Infection caused by a major wound in a jungle foxhole during WWII would have been difficult to treat even had the soldier been lucky enough to survive the initial injury.

You’re right and I suspect that as long as you can get air and food down I guess you could go on.

But say you kept living, what could be done then 1945? Grab some chair leather and sew a flap from his scalp to his neck? I suppose today doctors could print a new 3D bone structure.

There’s face transplant procedure, though it is really new operation.

Rubber prosthetics and masks were what was mostly done early in that time period. Skin grafts were known, and WWI saw great advances in that arena, but they began mostly to protect the wound site, rather than making everything look normal. Sir Harold Gillies was one of the pioneers in plastic surgery during this time, and many of his techniques are still used today. He worked with skilled sculptors and maskmakers, and one of his game changing ideas was to try and restore a soldier’s original appearance as much as possible, rather than just handing him any old rubber nose.

There’s an interesting article about Gillies and his contempararies here: http://www.smithsonianmag.com/history/faces-of-war-145799854/?no-ist

War may be hell, but it’s always been a great boon to medical advances.

I am not going to even do a link for this.

But: for those with strong stomachs, do an image search for
radical Mandibulectomy

There are surgical procedures which remove the jaw bone (mandible) and check bones.

What is left of the patient will make those who happen into the wrong room lose their lunches.

If you think the side-effects of chemo are bad, try this one: how much is getting another X months of “life” worth, and would you do it if this was the required procedure?

At a mujseum exhibition of surgical reconstruction, I watched a short film showing a man whop had had a great section of the center of his face removed. He had a plastic facial appliance that consisted on a nost, cheeks, and upper lip which 'snapped" into place on the stainless steel framework that was supporting the front of his skull. When he removed the appliance, you could see an astonishing amount inside his face, including a large cavity where his nose had been , along with the sinuses. It was both shocking and fascinating.

I was surprised they left it like that, but face transplantation wasn’t as far advanced then.

On the other hand, I’m sure that this was a gradual and managed loss. I doubt if a traumatic loss as the OP describes could have been salvaged, especially back in the 1940s in the middle of a war zone.

To address the last sentence above: I was a CT Tech at a Level I Trauma hospital, and I did a number of 3-D recon’d CT scans for exactly that purpose. One extreme case, in particular: A young woman had her entire face blown away by an ‘accidental’ blast from a 12g shotgun - no cranial injury or such. All vitals were reasonably stable w/ the appropriate EMS/Trauma Doc’s assistance, but no eyes. anterior mandible, etc. The 3-D company rep wasw present to make sure he got the data he needed, and was kind enough to stop by at a later date to show me the pics of the structure(s) made by his company. Cool tech, but definitely not around in '45.

Back in the 1860s, Dr. Gurdon Buck performed about 30 facial reconstructions of injuries stemming from the Civil War. The case that seems to be best documented, however, arose not from a combat injury but from a soldier suffering gangrene in his face (the past is another country) and having had one of his cheekbones removed.

Oops, missed that this was already posted. Sorry! And I did read the thread first, too…

Reposting as I just remembered something my daughter pointed out to me a week or so ago. It was about a 3-D modeled implant, so relevant, I guess, in the advancement of medical tech.

Here’s a link to it.

Basically, a person had an aggressive cancer that affected the top two cervical vertebrae (at least) and historically fixing the structure(s) were very difficult, if not almost always failures. About two weeks ago, this person received new 3-D model-based cervical vertebrae (C1/C2 at least), which are in VERY tough place to work on surgically).

According to the article, the patient is recovering as well as can be expected (!).

To me, this is quite revolutionary as it may change the approach to chronic spinal (and other type) issues - “we’ll just replace it instead of trying to patch it up with an osseous source of tissue” like is common nowadays (like my lumbar spine required years ago due to stenosis). I call it revolutionary as it was the first attempt to replace vertebrae with an artificial ones, fwiw. And it seems so far to be working.

I know this is a bit off-topic (non-facial), but thought it may be of interest and of some relevance in the context of what can be done nowadays. A face is soooo much easier to do than those two particular vertevrae are, no doubt, afaik.

I’ve seen the replacement vertebrae and it’s remarkable. I only wish this type of tech was available when I was fused. I can tell you from experience, what they did to me was a barbaric failure.

The antiwar book Krieg dem Kriege contains many photos of WWI soldiers who survived horrific facial injuries. Googling that or “War Against War” (the English title) will give you some idea.

No mention of the dude from Boardwalk Empire? People didn’t often survive wounds like that, but some did, and they got prosthetic faces to cover their horrific scars with.

That’s pretty much what happened to Roger Ebert. :frowning: I don’t care what he said, that man had no quality of life in his final years IMNSHO.

This man most likely had some kind of cancer. Facial prostheses are still used today when reconstructive surgery isn’t feasible.

Noma (cancrum oris) is still a common problem in the tropics. There’s a photograph that isn’t all that grisly, until you realize he isn’t baring his teeth on purpose.

How nearly realistic and “normal” would a facial prosthetic need to be, in order to not be seen as gruesome?

I would think that any “almost normal looking” facial prosthetic would put the patient right square into the “uncanny valley”, possibly the worst place to be.

No way, check the picture I linked to above. (I’m too squeamish to check many of the other links in this thread, but they probably concur.) Even the uncanny valley is light years better than walking around with a giant gaping hole where your face used to be.

That link is misformed so you can click all you want. :smiley:

But the correct link, including the missing close parenthesis, is kinda squicky.

I emphasized the last word because EEK! :eek: (But there are no pictures of that in the article.)