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Case Report
Conservative management of traumatic pneumocephalus and primary reconstruction following a self-inflicted midfacial gunshot wound: A case report
1 Department of Oral and Maxillofacial Surgery, Moi Teaching and Referral Hospital/Moi University School of Dentistry, Eldoret, Kenya
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Dennis Cheruiyot
Department of Oral and Maxillofacial Surgery, Moi Teaching and Referral Hospital, P.O. Box 3, Eldoret 30100,
Kenya
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Article ID: 100048D01DC2026
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Cheruiyot D, Rakewa S, Thuku F, Koech L, Wamalwa E. Conservative management of traumatic pneumocephalus and primary reconstruction following a self-inflicted midfacial gunshot wound: A case report. Edorium J Dent 2026;13(2):1–8.ABSTRACT
Introduction: Gunshot wounds to the midface represent a profound surgical challenge integrating acute life-threatening pathophysiology with complex reconstruction. We report the multidisciplinary care of a 52-year-old man who sustained a self-inflicted gunshot injury to the midface, resulting in an extensive panfacial laceration, a dentoalveolar fracture, and minor traumatic pneumocephalus.
Case Report: Immediate care followed Advanced Trauma Life Support (ATLS) principles, prioritizing airway security and hemodynamic resuscitation. Computed tomography (CT) neuroimaging identified frontal lobe pneumocephalus in the absence of tension physiology, prompting a conservative neurosurgical strategy of watchful observation, short-course seizure prophylaxis, and targeted antimicrobial coverage. Operative management comprised thorough wound debridement with high-volume saline irrigation, followed by anatomically layered primary closure using absorbable deep sutures and interrupted non-absorbable monofilament skin sutures. Repeat CT at 24 hours demonstrated near-complete clearance of the intracranial air.
Conclusion: The patient achieved full recovery without neurological sequelae or wound infection, with satisfactory healing evident at the initial postoperative review. This case demonstrates that a structured, protocol-driven approach combining trauma resuscitation, selective non-operative management of intracranial complications, and precise soft tissue reconstruction yields favorable outcomes in high-energy craniofacial ballistic trauma.
Keywords: Ballistic trauma, Facial reconstruction, Gunshot wound, Maxillofacial surgery, Pneumocephalus
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Acknowledgments
The authors wish to acknowledge the nursing and ancillary staff of Moi Teaching and Referral Hospital whose dedicated care contributed to this patient’s recovery.
Artificial intelligence (AI) use in the article: No generative AI technology was used in the preparation, writing, or analysis of this manuscript.
Dennis Cheruiyot - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Shem Rakewa - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Francis Thuku - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Lionel Koech - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Exavier Wamalwa - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guaranter of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2026 Dennis Cheruiyot et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
