The role of maxillofacial radiologists in gunshot injuries: a hypothesized missile trajectory in two case reports

Abstract

Gunshot injuries are an emerging form of trauma that oral radiologists increasingly have to deal with. There are two main types of gunshot injuries: high-velocity and low-velocity bullet injuries. The outcome of high-velocity gunshot injury is usually fatal; however, a nonfatal low-velocity injury to the maxillofacial region is more likely to be encountered by the oral and maxillofacial radiologist. It is therefore important to up-to-date knowledge of ballistic science and its implications in the field of maxillofacial radiology. The ability of oral and maxillofacial radiologists to predict the missile trajectory will aid the assessment and localization of the damage caused by the bullet and its splinters. Predicting the missile trajectory may also be of help to law enforcement agencies and forensic scientists in determining the type of firearm used and direction of fire. This article, which examines two cases, attempts to highlight to the oral radiologist this emerging form of trauma and its implications.

Dental Management of Maxillofacial Ballistic Trauma

“…A ballistic injury, caused by a firearm or by the sudden explosion of ammunition, is rarely neat, clean, and predictable: due to a significant soft tissue and bone loss from the impact, this type of facial trauma represents a challenge for reconstructive surgery and for the final aesthetic and functional rehabilitation [ 1 ]. The damage that a bullet creates is unpredictable, and the management in planning and reconstructing a traumatic defect requires a multi-step approach and a multidisciplinary team [ 2 , 3 , 4 ]. In addition to the extensive damages to both soft and hard tissues, gunshot wounds cause deleterious physical and psychiatric effects, representing a complex set of challenges for the maxillofacial surgeon, the oral surgeon, the prosthodontist, and, sometimes, for the psychologist or psychiatrist [ 5 , 6 , 7 ].…”

“…Approximately two-thirds of gunshot injuries are caused by a single gunshot wound, resulting in 11% mortality within 24 h after trauma [ 15 ]. Ballistic injuries are responsible for 2–6% of facial fractures [ 17 ]; indeed, head and neck are one of the most commonly affected areas: more than 50% of attempted suicides, 14% of assaults, and 12% of accidental injuries [ 2 , 10 ]. A retrospective review of nearly 4100 gunshot wounds observed that about 6% involved the face [ 15 ].…”

Contribution of imaging in the initial management of ballistic trauma

“…It helps objectify the trajectory of the bullet with multi-plane reconstructions, assess the intra-parenchyma lesions, fractures and splinters and thereby determine the prognosis [21]. In the facial skeleton, 3D and denta-scanner reconstructions are of great help in assessing the injuries [22]. Nevertheless, the conventional x-ray and the CT-scan do not allow for a precise determination of the calibre of the projectile due to the fungiform deformation, fragmentation and mushroom effect of certain lead bullets whose tips are crushed, thereby increasing their diameter [5].…”

State of the art in the treatment of mandibular fractures caused by firearms: case report

“…According to Hough, "the only rule regarding the science of ballistics is that the bullet follows no rules" 8 . Thus, with regard to this type of injury, various factors that affect the physiopathology and extent of the trauma must be taken into account in each case, such as: caliber, composition, projectile velocity, shooting distance, angle of penetration, trajectory and direction of the transferred energy 3,[9][10][11][12] .…”