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Patients with gunshot injuries in the maxillofacial region should be resuscitated and subjected to a general examination in the emergency room. Chest X-rays and head CT scans should be performed on a routine basis, and in selected cases angiography and plain X-ray films of the cervical columns are also recommended. Treatment of the facial defects depends to some degree on the type of firearm involved, i.e. high velocity rifle, low velocity weapon or shotgun. The traditional treatment for war and civilian gunshot injuries to the face has been debridement, soft tissue closure and conservative treatment of fractures, with closed reduction and external fixation. This treatment may leave inadequate stabilization of remaining bone fragments, with collapse and later contraction of soft tissue. It fails to take advantage of the modern craniofacial and microsurgical techniques used in a more recent approach that can be termed initial final treatment of gunshot wounds. This treatment modality is recommended for civilian low velocity gunshot injuries and, after repeated debridements, also for injuries caused by shotguns and high velocity weapons.

59 microvascular graft transfers performed in 50 patients in our department since 1985 have been studied retrospectively. The indications for microvascular reconstruction were sequelae after tumour surgery in 38 patients, gunshot injury in seven, chronic osteomyelitis of the mandible in three, complication after jaw fracture in one patient, and atrophy of the alveolar ridge also in one patient. Transplants from the iliac crest, fibula, radius, radial forearm skin and jejunum were used. Three transplants were lost because of arterial thrombosis, giving a success rate of 94.9%. Complications were registered in 19 cases, the largest group being wound infections. 21 of the 50 patients have been treated with dental implants for total rehabilitation of masticatory function. Transfer of free vascularized bone and soft tissue grafts has greatly improved the functional and cosmetic results obtained in reconstructive surgery of the orofacial region.

Craniofacial surgery is the term given to surgical techniques which allow combined access to the neurocranium and the facial skeleton. These techniques are applied primarily for treatment of fractures of the frontal/nasal/orbital regions, tumours of the orbits and the anterior cranial base, and congenital malformations, including simple or complex craniofacial synostoses, e.g. Crouzon and Apert syndromes. Indications for surgical treatment and the timing of the surgery are discussed. In addition, the most common surgical techniques are described and some clinical cases are presented.

Multiple organ failure may develop as a consequence of defective tissue oxygenation, particularly in the gut. Measurements of intramucosal pH (pHi), accomplished by means of a tonometer placed in the stomach or in the sigmoid colon, seem to monitor the degree of mucosal oxygenation very good. The tonometer technique is noninvasive and easy to perform. pHi may be useful as an index to guide therapeutic interventions in critically ill patients.

Individually adapted acrylic ocular prostheses are presented as an alternative to glass prostheses, which up to now have been the technique available to Norwegian patients who have lost an eye. The article describes the technique used to produce acrylic eyes and sums up the advantages of acrylic eyes compared with prostheses of glass.