Historically, head and
neck injuries constituted 16 to 20% of all nonfatal combat
injuries. However, advances in body and vehicle armor in the context of the use of ambushes and improvised
explosive devices by enemy combatants have resulted in fewer fatalities from head and neck
wounds, and thus the incidence of nonfatal head and
neck injuries has risen to as high as 52%. Despite this increase, data regarding specific injury distributions, surgical cases, and approaches to repair are lacking in the current literature. We conducted a study to systematically review the current literature regarding head and
neck injuries and reconstructions during Operation Iraqi Freedom and Operation Enduring Freedom-Afghanistan. We found 44 articles that met our inclusion criteria. These articles covered 17,461 head and neck
wounds sustained by 12,105 patients. Superficial soft-tissue
facial injuries were most common
wounds (31.7% of cases), followed by
wounds to the neck (25.2%) and midface (17.9%). The 44 articles listed 5,122 discrete surgical reports covering 5,758 procedures. Of these procedures, simple facial
laceration repairs (25.2%) and ophthalmologic surgeries (12.1%) were the most common soft-tissue repairs, and
mandibular reconstructions (11.3%) were the most common type of bony reconstruction. Major flap reconstructions for coverage were required in only 0.4% of procedures. This information will be valuable for educating those involved in otolaryngology training programs, as well as civilian otolaryngologists regarding the types of injury patterns they should expect to see and treat in the returning veteran population.