Unusual route of a bullet: From scapula to eye

Abstract

Herein, an awkward case of globe perforation with a bullet-entering from the right posterior scapular region and leaving the body from the right orbit through the eye - is reported. Route of the bullet could be devastating - as it passed through the neck and the maxillofacial region-however by chance no vital damage occurred. Its path was assessed by plain radiography and computed tomography scans. Sometimes prediction of the trajectory is very difficult without additional radiological investigations. Especially, in the case of any high velocity projectile wounding, physician must be aware of the fact that the bullet's course will not be a linear but most probably a complicated one. Prognosis of the injury depends on the path of the bullet or shrapnel fragment, close clinical observation, an open-minded approach, and the multidisciplinary care. Moreover, even the crime investigation might be needed.

Atypical gunshot injury to the neck with an unexpected nonlinear bullet trajectory: a case report and review of the literature

“…To our knowledge, this is the first report of a patient with a gunshot injury wherein the bullet almost transversely penetrated the entire neck, across its deep structures to the contralateral side of the shoulder, notably via a nonlinear path, traveling anterior to the left carotid sheath and posterior to the right carotid sheath without damaging any vital organs. Although various patients with atypical head and neck gunshot injuries who survived without fatal organ damage have been reported [10,[14][15][16][17][18][19][20][21][22], those with a true nonlinear bullet trajectory are limited to a few reports [10,15,21], where trajectories were implied to match the fascial planes with the least tissue resistance. Unlike our case, those reports suggested that the bullet penetrated the face from the masseteric region through the parapharyngeal and retropharyngeal spaces to the contralateral prestyloid space [10], or longitudinally passed through the unilateral side of the neck to the face from the caudal to the cranial side [15,21].…”

“…Although various patients with atypical head and neck gunshot injuries who survived without fatal organ damage have been reported [10,[14][15][16][17][18][19][20][21][22], those with a true nonlinear bullet trajectory are limited to a few reports [10,15,21], where trajectories were implied to match the fascial planes with the least tissue resistance. Unlike our case, those reports suggested that the bullet penetrated the face from the masseteric region through the parapharyngeal and retropharyngeal spaces to the contralateral prestyloid space [10], or longitudinally passed through the unilateral side of the neck to the face from the caudal to the cranial side [15,21]. Intriguingly, a couple of other case reports showed an unexpected route of a bullet that entered from the face, penetrated the facial cranium, passed through the nasopharynx, and ended up in the gastrointestinal tract by involuntary swallowing [16,19].…”

Atypical Gunshot Injury Traversing the Neck with an Unexpected Nonlinear Bullet Trajectory: a Case Report and Review of the Literature

“…To our knowledge, this is the first report of a patient who survived a gunshot injury wherein the bullet traversed the entire neck across its deep structures to the contralateral side of the shoulder, notably via a nonlinear path, traveling anterior to the left carotid sheath and posterior to the right carotid sheath without damaging any vital organs. Although various patients with atypical head and neck gunshot injuries who survived without fatal organ damage have been reported [3][4][5][16][17][18][19][20][21][22], those with a true nonlinear bullet trajectory are limited to only a few reports [3][4][5], where trajectories were implied to match the fascial planes with the least tissue resistance. Unlike our case, those reports suggested that the bullet penetrated the face from the masseteric region through the parapharyngeal and retropharyngeal spaces to the contralateral prestyloid space [4], or longitudinally passed through the unilateral side of the neck to the face from the caudal to the cranial side [3,5].…”

“…Although various patients with atypical head and neck gunshot injuries who survived without fatal organ damage have been reported [3][4][5][16][17][18][19][20][21][22], those with a true nonlinear bullet trajectory are limited to only a few reports [3][4][5], where trajectories were implied to match the fascial planes with the least tissue resistance. Unlike our case, those reports suggested that the bullet penetrated the face from the masseteric region through the parapharyngeal and retropharyngeal spaces to the contralateral prestyloid space [4], or longitudinally passed through the unilateral side of the neck to the face from the caudal to the cranial side [3,5]. Intriguingly, a couple of other case reports showed an unexpected route of a bullet that entered from the face, penetrated the facial cranium, passed through the nasopharynx, and ended up in the gastrointestinal tract by involuntary swallowing [17,20].…”

“…Although a bullet is commonly thought to travel through the body in a straight line, a few patients with head and neck gunshot injuries who survived without lethal organ damage thanks to a nonlinear bullet trajectory have been reported [3][4][5]. However, there is no report of a patient who survived a gunshot wound transversely penetrating the entire neck across its deep structures.…”