Stable to Unstable: Modern Approaches to Panfacial Trauma and Facial Gunshot Wounds (with Drs. Andrew Jenzer and Damian Findlay)

Complex facial trauma can look overwhelming, but the best outcomes often begin with resisting the urge to do too much, too soon. In this episode of Everyday Oral Surgery, Dr. Grant Stucki is joined by Drs. Andrew Jenzer and Damian Findlay for the final installment in the podcast’s trauma series, focusing on panfacial fractures and gunshot wounds. They break down how to approach these high-stakes cases systematically, from stabilizing the patient and coordinating with other specialties to identifying reliable reference points and planning reconstruction from stable structures outward. The conversation also explores surgical sequencing, staged procedures, virtual surgical planning, and the unique tissue damage and contamination associated with ballistic injuries. Throughout, they emphasize careful planning, knowing when to reassess, and avoiding “hero surgery,” namely, attempting a complex reconstruction all at once when it may be better handled in stages. Listen in for a practical discussion on managing complex panfacial trauma with patience, structure, and sound surgical judgment. **Key Points From This Episode:** - Defining panfacial fractures and the challenges of restoring facial structure and function. - Prioritizing stabilization and multidisciplinary care in early trauma management. - Planning airway management, nutrition, imaging, and surgery in complex facial trauma cases. - Why careful planning and staged surgery can be safer than rushing into major reconstruction. - Using stable anatomical reference points to guide panfacial reconstruction. - Comparing bottom-up, top-down, outside-in, and inside-out sequencing. - How virtual surgical planning and 3D tools can support complex cases. - When severe panfacial trauma may be better managed across multiple operations. - How ballistic injuries differ from other forms of facial trauma. - Understanding entry and exit wounds, cavitation, tissue damage, and delayed tissue death. - Why gunshot wounds require aggressive irrigation, debridement, and infection management. - Managing bullet fragments and preserving chain of custody. - Reconstructing hard- and soft-tissue defects after severe ballistic trauma. - Applying the same core principles across panfacial and gunshot trauma: stabilize, assess, plan, and build from stable to unstable. - Why surgeons should avoid “hero surgery,” ask for help, and accept that secondary reconstruction may be necessary. **Links Mentioned in Today’s Episode:** Dr. Damian Findlay — https://ofsinstitute.com/damian-findlay/ Dr. Damian Findlay Email — [damianfindlay@gmail.com](mailto:damianfindlay@gmail.com) Dr. Andrew Jenzer — https://surgery.duke.edu/profile/andrew-clark-jenzer  Dr. Andrew Jenzer – [andrew.jenzer@gmail.com](mailto:andrew.jenzer@gmail.com) St. Louis Oral & Maxillofacial Surgery Review — https://stlomfsreview.com/ *Oral Board Review for Oral and Maxillofacial Surgery* — https://www.amazon.com/dp/3030488799?lv=shuf&channelId=500&plpRedirect=mhFallback ImmersiveTouch — immersivetouch.com Zimmer Biomet CMF Trauma & Reconstruction — https://www.zimmerbiomet.eu/en/product-range/cmf-trauma-and-reconstruction AROMS® (Advancing Resources of OMS) — goaroms.com Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/  Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/  Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/ Dr. Grant Stucki Email — [grantstucki@gmail.com](mailto:grantstucki@gmail.com) Dr. Grant Stucki Phone — 720-441-6059