Prolonged Field Care Podcast

PFC Podcast 266: Managing Penetrating Facial Trauma

Feb 16, 2026
Borja Langdana, a maxillofacial surgeon with international experience in emergency dentistry and facial trauma care. He talks about why jaw wiring is a crucial, teachable skill in austere settings. They cover modern penetrating facial injury patterns from drones and shrapnel. Practical techniques discussed include hemorrhage control, Foley and balloon packing, airway urgency and field-friendly jaw stabilization like MiniTies.
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INSIGHT

Face Bleeds Often Respond To Packing And Time

  • Facial vessels are small and often controllable with packing and pressure; many will vasospasm within 10–20 minutes.
  • Prioritize packing individual shrapnel tracts and sustained pressure rather than futile vessel hunting in the field.
INSIGHT

Shifting Trauma Patterns Raise Facial Injury Burden

  • Modern conflicts produce more top-down facial injuries from drones and indirect fire, increasing complex midface and skull-base wounds.
  • Borja and Andrew note higher facial injury rates and mortality in recent conflicts compared with past wars.
ADVICE

Midface Tamponade With Dual Balloons

  • Use two nasal balloons (Foley or Epistat) and an oral bite block plus cervical support to tamponade midface bleeding behind the maxilla.
  • Inflate with liquid (use 30 ml Foley) and add an anterior hemostatic pack like Celox for better clot reinforcement.
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