Utilizing maxillofacial injury severity score (MFISS) in postmortem head gunshot imaging for surgical planning and preventative treatment assessment

Philadelphia, PA

Gunshot injuries to the head represent a major clinical and forensic challenge due to their complexity and multifaceted nature of the trauma. Various pre-operative methods exist to assess extent of craniofacial damage and patient outcomes. One such method is the Maxillofacial Injury Severity Score (MFISS). The MFISS is a trauma scoring system used by craniofacial reconstructive surgeons to categorize the degree of facial trauma based on hard and soft tissue damage. The system is broken down into three hard tissue and one soft tissue classification. All classifications are scored on a 0 to 3 scale ranging from no damage to intense trauma respectively.

While techniques such as the MFISS offer a framework for assessing craniofacial trauma, its current application may not fully address the clinical and forensic complexities associated with these injuries. Utilizing postmortem cases may help address this gap because they can provide a source of variable degrees of craniofacial trauma cases that can be observed, measured, and analyzed.

This study hypothesizes that applying the MFISS to postmortem head gunshot imaging will provide valuable data for preventative treatment strategies and enhance the accuracy of injury assessment utilizing computed tomography (CT). The research uses a sample of 36 postmortem Computed Tomography (CT) scans from the New Mexico Decedent Image Database (NMDID). Three-dimensional hard and soft tissue reconstructions were created for each case utilizing the medical imaging software Horos (Horosproject.org). The two-dimensional CT images were used to track projectile pathway through the skull and the and the three-dimensional reconstructions were examined to establish a total MFISS score.

A regression analysis was performed on the data utilizing the Statistical Package for the Social Sciences version 30 (IBM SPSS Statistics) to assess reliability of the Maxillofacial Injury Severity Score in determining likelihood of survivability of head gunshot trauma victims. The results of the regression analysis indicate a statistical significance in identifying likelihood of survivability when considering the total classification score. Total MFISS score, not individual classification zone, provides the most reliable assessment of gunshot trauma survivability.