Craniomaxillofacial Falling Bullet Injuries and Management

Shuker, Sabri T.; Sadda, Raid

doi:10.1016/j.joms.2009.06.039

Cited by 15 publications

(20 citation statements)

References 13 publications

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“…The entire extent of such injuries can be difficult to identify, and removal of the lodged bullet in the cranio-maxillofacial area to prevent secondary complications and reduce the chance of secondary infection can be more complicated than in other parts of the body [5]. Injuries are typically high-energy transfer in nature and the bullet is potentially lethal within a range of up to 200m.…”

Section: Discussionmentioning

confidence: 99%

“…These are basically high-energy transfer injuries. A 'falling’ bullet would be low-energy transfer in nature and have any size and shape of entry wound [5]. It is also unlikely to have been fired from a distance of only about 70m.…”

Section: Discussionmentioning

confidence: 99%

“…In general, high-energy transfer gunshots fired at close range inflict the most damage [4]. A classic weapon inflicting this mode of injury is the AK-47 rifle (a common assault rifle, submachine gun type) [5]. The extent of tissue damage depends on: internal lacerations, compression of tissues and the temporary cavitation along the projectile path [6].…”

Section: Introductionmentioning

confidence: 99%

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Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

2014

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IntroductionGunshot injuries of the head and neck from the AK-47 rifle (a common assault rifle, submachine gun type) are a significant contributor to morbidity and mortality among civilians in Sub-Saharan Africa. They may cause significant damage to the closely arranged structures in this region, and the bullet’s trajectory can be very difficult to determine. We present an unusual case of gunshot injury with an atypical bullet entry wound, profound injury to the face, lodgment in the right carotid sheath, and 'wandering’; a first of its kind in East Africa.Case presentationA 27-year-old African-Ugandan woman of Nilotic ethnicity was referred to the Accident and Emergency Department of a tertiary hospital in Uganda, having sustained complex injuries due to an inadvertent AK-47 rifle gunshot injury. The gunshot injury was to the right side of her face with a large ragged entry wound and no exit wound. Prior basic wound care and radiological imaging showed a comminuted fracture of her mandible with lodgment of the bullet in her neck, anterior to her sixth and seventh cervical vertebrae. Standard debridement of her wound was done. A computed tomography scan showed an apparent cephalad shift ('wandering’) of the bullet, leaving it lying partially anterior to her fifth cervical vertebra as well as within her carotid sheath. Other injuries were to her facial and trigeminal nerves, and her middle ear. The 'wandering’ bullet was successfully removed surgically. It had caused no damage to any part of her neck structure.ConclusionAK-47 rifle bullet injuries may present with uncharacteristically large entry wounds and cause complex structural injuries at the area of impact. The consequent trajectory is difficult to predict making regional examination and radiological investigations essential in management. Bullets may be retained, leaving no exit wound. Securing the airway, controlling hemorrhage and identifying other injuries are the first vital steps. This case illustrates all these interventions and the important decision to extract the entrapped bullet from the patient’s neck because it had started to 'wander’ and could have caused grave injury over time with further migration. Maxillofacial, plastic, trauma, general and military surgeons, otorhinolaryngologists and emergency physicians can gain from this experience because it calls for a multidisciplinary team approach.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

2014

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“…Vol.3 No.1:2 wound has any size and shape [7]. A destabilized bullet creates atypical gunshot inlet as it enters the body at an angle or sideways.…”

Section: Journal Of Medical Toxicology and Clinical Forensic Medicinementioning

confidence: 99%

Medico Legal Autopsy of an Atypical Firearm Skull Inlet: A Case Report

Ibrahim¹,

Mahdi²

2017

J Med Toxicol Clin Forens Med

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Firearm injuries contribute to considerable morbidity and mortality. The ricocheting bullet is a high-velocity bullet after interacting with intermediate object. Ricocheting bullet produces a unique wound, its mechanics have been discussed from time to time. The case presented an atypical presentation of firearm entrance wound , where the entry wound situated on left temporal skull region with surrounding abrasions in addition the bullet entered the cranial cavity to cause an exit fracture defect situated on right temporal skull region with brain disruption. Our case emphasizes that forensic doctors should carefully interpret the properties of atypical firearm entry wound.

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“…(8) Bullets with a caliber of 0.30 may have a terminal velocity of 300 fps, whereas larger bullets of 0.50 caliber may have a velocity of 500 fps. (9) The trajectory of a bullet, called "horizontal projectile motion, " will continue to accelerate when shot in the air until it arrives at a point where its weight is equal to the resistance of the air. Although when falling, these bullets are not at optimum velocity, they might still reach 600 fps while falling down.…”

Section: Introductionmentioning

confidence: 99%

Stray bullet injuries in a tertiary care center

2016

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Craniomaxillofacial Falling Bullet Injuries and Management

Cited by 15 publications

References 13 publications

Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

Atypical gunshot injury to the right side of the face with the bullet lodged in the carotid sheath: a case report

Medico Legal Autopsy of an Atypical Firearm Skull Inlet: A Case Report

Stray bullet injuries in a tertiary care center

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