{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T19:24:06Z","timestamp":1790364246833,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T00:00:00Z","timestamp":1781222400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Modern warfare has introduced novel mechanisms of injury, particularly drone-induced blast trauma, resulting in complex craniomaxillofacial injuries. These injuries differ substantially from typical ballistic wounds and require adapted surgical strategies. This study was conducted to evaluate the clinical characteristics, management approaches, and long-term outcomes of midfacial blast injuries. Methods: A retrospective analytical study was conducted on 41 patients with drone-induced midfacial blast injuries treated at a tertiary referral center in Armenia following the 2020 Nagorno-Karabakh War. All patients underwent surgical management after initial stabilization and were followed for 5 years. Clinical outcomes, complications, and reconstructive needs were assessed. Results: All patients presented with comminuted midfacial fractures, which were frequently associated with polytrauma (87.8%). Burns were observed in 82.9% of cases. Surgical management included radical debridement and early definitive osteosynthesis using titanium fixation systems. No cases of postoperative osteomyelitis, bone sequestration, or implant failure were observed during the 5-year follow-up period. Patients with extensive soft tissue defects, particularly nasal and lip amputations, required multiple reconstructive procedures. Long-term follow-up revealed progressive soft tissue thinning over titanium meshes, especially in the zygomatico-orbital region, necessitating secondary interventions such as lipofilling. Conclusions: Drone-induced midfacial blast injuries represent a distinct and severe form of trauma. Early definitive reconstruction following adequate debridement was associated with favorable outcomes. However, soft tissue reconstruction remains challenging and often requires staged procedures. Long-term follow-up is essential to manage delayed complications and optimize aesthetic outcomes.<\/jats:p>","DOI":"10.3390\/jcm15124588","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T08:57:58Z","timestamp":1781513878000},"page":"4588","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Drone-Induced Midfacial Blast Injuries: Early Definitive Reconstruction and 5-Year Outcomes from a Single-Center Cohort"],"prefix":"10.3390","volume":"15","author":[{"given":"Anna","family":"Poghosyan","sequence":"first","affiliation":[{"name":"Department of ENT and Maxillo-Facial Surgery, \u201cHeratsi\u201d No 1 Hospital, Yerevan State Medical University, 7 Heratsi Str., Yerevan 0025, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Misakyan","sequence":"additional","affiliation":[{"name":"Department of ENT and Maxillo-Facial Surgery, \u201cHeratsi\u201d No 1 Hospital, Yerevan State Medical University, 7 Heratsi Str., Yerevan 0025, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gurgen","family":"Mkhitaryan","sequence":"additional","affiliation":[{"name":"Department of ENT and Maxillo-Facial Surgery, \u201cHeratsi\u201d No 1 Hospital, Yerevan State Medical University, 7 Heratsi Str., Yerevan 0025, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davit","family":"Minasyan","sequence":"additional","affiliation":[{"name":"Department of ENT and Maxillo-Facial Surgery, \u201cHeratsi\u201d No 1 Hospital, Yerevan State Medical University, 7 Heratsi Str., Yerevan 0025, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irina","family":"Malkhasyan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, \u201cHeratsi\u201d No 1 Hospital, Yerevan State Medical University, 7 Heratsi Str., Yerevan 0025, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayk","family":"Petrosyan","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, \u201cHeratsi\u201d No 1 Hospital, Yerevan State Medical University, 7 Heratsi Str., Yerevan 0025, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Frangulyan","sequence":"additional","affiliation":[{"name":"Department of Radiology, \u201cHeratsi\u201d No 1 Hospital, Yerevan State Medical University, 7 Heratsi Str., Yerevan 0025, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aren","family":"Bablumyan","sequence":"additional","affiliation":[{"name":"Administrative Department, \u201cHeratsi\u201d No 1 Hospital, Yerevan State Medical University, 7 Heratsi Str., Yerevan 0025, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armen","family":"Minasyan","sequence":"additional","affiliation":[{"name":"Administrative Department, \u201cHeratsi\u201d No 1 Hospital, Yerevan State Medical University, 7 Heratsi Str., Yerevan 0025, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armen","family":"Muradyan","sequence":"additional","affiliation":[{"name":"Administrative Department, \u201cHeratsi\u201d No 1 Hospital, Yerevan State Medical University, 7 Heratsi Str., Yerevan 0025, Armenia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1007\/s10006-018-0710-1","article-title":"Mandibular war injuries caused by bullets and shell fragments: A comparative study","volume":"22","year":"2018","journal-title":"Oral Maxillofac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"S49","DOI":"10.1097\/TA.0000000000003700","article-title":"The new face of war: Craniofacial injuries from Operation Inherent Resolve","volume":"93","author":"Neubauer","year":"2022","journal-title":"J. Trauma. Acute Care Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"51","DOI":"10.7181\/acfs.2024.0074","article-title":"War-related maxillofacial injuries in Ukraine: A retrospective multicenter study","volume":"26","author":"Prysiazhniuk","year":"2025","journal-title":"Arch. Craniofac. Surg."},{"key":"ref_4","first-page":"29","article-title":"Human Response and Injury Resulting from Head Impacts with Unmanned Aircraft Systems","volume":"63","author":"Stark","year":"2019","journal-title":"Stapp. Car. Crash J."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Pepper, T., Kim, M.H., McMillan, D., Cantrell, S., Scialdone, A., Nasthas, A., Erdmann, R., Manson, P.N., and Powers, D.B. (2026). Management Protocol for Ballistic and Other High-Energy Avulsive Facial Injuries\u2014An Update for the 21st Century. Craniomaxillofac. Trauma Reconstr., 19.","DOI":"10.3390\/cmtr19010014"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e877","DOI":"10.1002\/ams2.877","article-title":"Craniomaxillofacial trauma in war-torn nations: Incidence, management gaps, and recommendations","volume":"10","author":"Adebusoye","year":"2023","journal-title":"Acute Med. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1055\/s-0036-1583541","article-title":"Management of Battlefield Injuries to the Skull Base","volume":"77","author":"Stevens","year":"2016","journal-title":"J. Neurol. Surg. B Skull Base."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Hardt, N., and Kuttenberger, J. (2010). Mechanisms of Craniofacial Fractures. Craniofacial Trauma, Springer.","DOI":"10.1007\/978-3-540-33041-7"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"39","DOI":"10.17430\/jhs\/190258","article-title":"Electrophisiological measures of auditory impairment in noise-exposed, normal hearing soldiers","volume":"14","author":"Sargsyan","year":"2024","journal-title":"J. Hear. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e243","DOI":"10.1016\/S2214-109X(20)30510-6","article-title":"War in the Time of COVID-19: Humanitarian Catastrophe in Nagorno-Karabakh and Armenia","volume":"9","author":"Kazaryan","year":"2020","journal-title":"Lancet Glob. Health"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.ajem.2024.08.001","article-title":"Analyzing unmanned aerial vehicle (drone) attacks; a disaster medicine perspective","volume":"84","author":"Shapovalov","year":"2024","journal-title":"Am. J. Emerg. Med."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Feng, X., Yang, Z., and Nie, Y. (2024). Investigation of the Overall Damage Assessment Method Used for Unmanned Aerial Vehicles Subjected to Blast Waves. Aerospace, 11.","DOI":"10.3390\/aerospace11080651"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1434","DOI":"10.1097\/SCS.0000000000006600","article-title":"Trauma in Iraq\u2019s Wars: Assessment and Management of Craniofacial Injury","volume":"31","author":"Samaha","year":"2020","journal-title":"J. Craniofac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"rjae709","DOI":"10.1093\/jscr\/rjae709","article-title":"A novel approach used for reconstruction of facial blast wound injury\u2014A case report from the Russo-Ukrainian war","volume":"2025","author":"Lurin","year":"2025","journal-title":"J. Surg. Case Rep."},{"key":"ref_15","first-page":"121","article-title":"Some Features of Mine-Explosive Wounds due to Hostilities Using Unmanned Aerial Vehicles\u2014Combat Drones","volume":"5","author":"Gumeniuk","year":"2021","journal-title":"EC Emerg. Med. Crit. Care"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Yi, Y., He, X., Wu, Y., and Wang, D. (2024). Global, regional, and national burden of incidence, prevalence, and years lived with disability for facial fractures from 1990 to 2019: A systematic analysis for the Global Burden of Disease study 2019. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-04206-9"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.injury.2016.08.009","article-title":"The surgical management of facial trauma in British soldiers during combat operations in Afghanistan","volume":"48","author":"Wordsworth","year":"2017","journal-title":"Injury"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"315","DOI":"10.7205\/MILMED-D-14-00345","article-title":"Characteristics of maxillofacial injuries and safety of in-theater facial fracture repair in severe combat trauma","volume":"180","author":"Keller","year":"2015","journal-title":"Mil. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1136\/jramc-2019-001304","article-title":"Syrian Civil War: A systematic review of trauma casualty epidemiology","volume":"166","author":"McIntyre","year":"2020","journal-title":"BMJ Mil. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1177\/15485129231207660","article-title":"The future of military medical evacuation: Literature analysis focused on the potential adoption of emerging technologies and advanced decision-analysis techniques","volume":"22","author":"Biswas","year":"2023","journal-title":"J. Def. Model. Simul."},{"key":"ref_21","unstructured":"(2019, July 12). ATP 4-02.2. Medical Evacuation. Headquarters, Department of the Army. Available online: https:\/\/armypubs.army.mil\/epubs\/DR_pubs\/DR_a\/pdf\/web\/ARN17834_ATP%204-02x2%20FINAL%20WEB.pdf."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"e1864","DOI":"10.7205\/MILMED-D-17-00007","article-title":"Evaluating the military medical evacuation chain: Need for expeditious evacuation out of theater","volume":"182","author":"Plat","year":"2017","journal-title":"Mil. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1630","DOI":"10.1016\/j.joms.2007.11.028","article-title":"Incidence and severity of maxillofacial injuries during the Second Lebanon War among Israeli soldiers and civilians","volume":"66","author":"Levin","year":"2008","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"18","DOI":"10.1136\/jramc-2018-000942","article-title":"Fatal head and neck injuries in military underbody blast casualties","volume":"165","author":"Stewart","year":"2019","journal-title":"J. R. Army Med. Corps"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1097\/SCS.0000000000005440","article-title":"Incidence and severity of maxillofacial injuries during the Syrian Civil War in Syrian soldiers and civilians","volume":"30","author":"Ucak","year":"2019","journal-title":"J. Craniofac. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1093\/milmed\/usaa567","article-title":"The Relationship Between Blast-related Hearing Threshold Shift and Insomnia in U.S. Military Personnel","volume":"186","author":"MacGregor","year":"2021","journal-title":"Mil. Med."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Dinu, C., Tamas, T., Agrigoroaei, G., Stoia, S., Opris, H., Bran, S., Armencea, G., and Manea, A. (2022). Prospective Evaluation of Intraorbital Soft Tissue Atrophy after Posttraumatic Bone Reconstruction: A Risk Factor for Enophthalmos. J. Pers. Med., 12.","DOI":"10.20944\/preprints202207.0017.v1"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Hartmann, A., and Seiler, M. (2020). Minimizing risk of customized titanium mesh exposures\u2014A retrospective analysis. BMC Oral Health, 20.","DOI":"10.1186\/s12903-020-1023-y"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1055\/s-0033-1333877","article-title":"The role of fat grafting in the treatment of posttraumatic maxillofacial deformities","volume":"6","author":"Arcuri","year":"2013","journal-title":"Craniomaxillofac. Trauma Reconstr."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4588\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T09:39:41Z","timestamp":1781516381000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4588"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,12]]},"references-count":29,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124588"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124588","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,12]]}}}