Presentation
Penetrating trauma to the face, specifically facial gunshot injury. Request for plain films and CT.
Patient Data
Facial gunshot injury with a significant volume of metallic shrapnel along the oblique anteroposterior trajectory and a residual large bullet fragment adjacent to the left temporomandibular joint.
The patient is intubated.
There is a frontal gold tooth. There is poor identification of the fractured teeth on the skull series.
The portable chest X-ray confirms a satisfactorily sited ETT with overlying ECG leads.
Hilar congestion and prominent broncho vascular markings are normal in a supine and underinspired X-ray with a magnified cardiomediastinal contour.
There is an aspirated molar tooth impacted within the left main bronchus.
There is ingested metallic shrapnel within the stomach.
Image courtesy: Dr VKS Bhagwandas.
Case Discussion
A case of penetrating trauma to the facial bones specifically, a gunshot injury. There is a confirmed history of solitary facial penetration and injury. Thoracic, abdominal, pelvic or other skeletal injury is absent.
The tooth aspiration is either due to the actual gunshot injury and accidental aspiration thereafter or possibly post-intubation in the ER.
The presence of shrapnel within the stomach confirmed on CT imaging with the documented absence of acute or previous abdominal trauma suggests accidental ingestion. Again this may be following the gunshot injury or due to oral manipulation at the time of intubation.
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