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Journal of Maxillofacial and Oral Surgery

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01-12-2021 | Frontobasal Fracture | Clinical Paper

Orbito-Cranial Gunshot Injuries with Retained Sinonasal Bullets

Authors: Gerrit Viljoen, Sean Tromp, Nicholas Goncalves, Patrick Semple, Darlene Lubbe

Published in: Journal of Maxillofacial and Oral Surgery | Issue 4/2021

Abstract

Introduction

Gunshot injuries to the sino-orbital region are rare. In South Africa, where gunshot injuries are common, sino-orbital gunshot injuries are encountered. Sino-orbital gunshot injuries are associated with trauma to surrounding facial and intracranial structures. Therefore, the management of these injuries may be complex and often requires an interdisciplinary approach.

Aims

To review the management of orbito-cranial gunshot injuries with retained sinonasal bullets.

Patients and methods

Three cases of orbito-cranial gunshot injuries with retained sinonasal bullets were reviewed. Two cases were complicated by cerebrospinal fluid leaks with ensuing meningitis. The retained bullets in all three cases were successfully removed via a transnasal endoscopic approach.

Conclusion

Sino-orbital gunshot injuries are rare, but may be encountered in areas with high frequencies of gun violence. An associated anterior skull base fracture with CSF rhinorrhoea poses a risk for meningitis and a low threshold for diagnosis and treatment of meningitis should be maintained. Retained bullets in the paranasal sinuses do not pose an immediate risk and may be removed on an elective basis.

Collaborators TGB of D 2016 I. (2016) Global mortality from firearms, 1990–2016. JAMA. 320(8):792–814. https://doi.org/10.1001/jama.2018.10060CrossRef

Fowler KA, Dahlberg LL, Haileyesus T, Annest JL (2015) Firearm injuries in the United States. Prev Med (Baltim) 79:5–14. https://doi.org/10.1016/j.ypmed.2015.06.002CrossRef

Blissitt PA (2006) Care of the critically Ill patient with penetrating head injury. Crit Care Nurs Clin North Am 18(3):321–332. https://doi.org/10.1016/j.ccell.2006.05.006CrossRefPubMed

Bowen DI, Magauran DM (1973) Ocular injuries caused by airgun pellets: an analysis of 105 cases. Br Med J 1(5849):333–337CrossRef

Semple P, Domingo Z (2001) Craniocerebral gunshot injuries in South Africa—a suggested management strategy. South African Med J 91(2):141–145

Rosenfeld JV (2002) Gunshot injury to the head and spine. J Clin Neurosci 9(1):9–16CrossRef

Martins RS, Siqueira MG, Santos MTS, Zanon-Collange N, Moraes OJS (2003) Prognostic factors and treatment of penetrating gunshot wounds to the head. Surg Neurol 60(2):98–104. https://doi.org/10.1016/S0090-3019(03)00302-1CrossRefPubMed

Kuhn F, Morris R, Witherspoon CD, Heimann K, Jeffers JB, Treister G (1996) A standardized classification of ocular trauma. Ophthalmology 103(2):240–243. https://doi.org/10.1016/S0161-6420(96)30710-0CrossRefPubMed

Pieramici DJ, Sternberg PJ, Aaberg S et al (1997) A system for classifying mechanical injuries of the eye (globe). Am J Ophthalmol 123(6):820–831. https://doi.org/10.1016/S0002-9394(14)71132-8CrossRefPubMed

10.

Sobaci G, Mutlu FM, Bayer A, Karagül S, Yildirim E (2000) Deadly weapon-related open-globe injuries: outcome assessment by the Ocular Trauma classification system. Am J Ophthalmol 129(1):47–53. https://doi.org/10.1016/S0002-9394(99)00254-8CrossRefPubMed

11.

Bodanapally UK, Sours C, Zhuo J, Shanmuganathan K (2015) Imaging of Traumatic brain injury. Radiol Clin North Am 53(4):695–715. https://doi.org/10.1016/j.rcl.2015.02.011CrossRefPubMed

12.

Currie S, Saleem N, Straiton JA, Macmullen-Price J, Warren DJ, Craven IJ (2016) Imaging assessment of traumatic brain injury. Postgrad Med J 92(1083):41–50CrossRef

13.

Dedini RD, Karacozoff AM, Shellock FG, Xu D, Mcclellan RT, Pekmezci M (2013) MRI issues for ballistic objects: information obtained. Spine J 13(7):815–822. https://doi.org/10.1016/j.spinee.2013.02.068CrossRefPubMed

14.

Dienstknecht T, Horst K, Sellei RM, Berner A, Nerlich M, Hardcastle TC (2012) Indications for bullet removal: overview of the literature, and clinical practice guidelines for European trauma surgeons. Eur J Trauma Emerg Surg 38(2):89–93. https://doi.org/10.1007/s00068-011-0170-xCrossRefPubMed

15.

Linden MA, Manton WI, Stewart RM, Thal ER, Feit H (1982) Lead poisoning from retained bullets. Pathogenesis, diagnosis, and management. Ann Surg 195(3):305–313CrossRef

16.

de Madureira PR, De Capitani EM, Vieira RJ, Sakuma AM, Toledo AS, Mello SM (2009) Lead poisoning due to gunshot bullet in contact with cerebrospinal fluid: case report. Sao Paulo Med J 127(1):52–54CrossRef

17.

Ben-David J, Fradis M, Podoshin L, Bartal AH (1981) Plasmacytoma arising in the vicinity of a foreign body in the nasal cavity. Laryngoscope 91(7):1150–1154. https://doi.org/10.1288/00005537-198107000-00013CrossRefPubMed

18.

Sifri ZC, Livingston DH, Lavery RF et al (2004) Value of repeat cranial computed axial tomography scanning in patients with minimal head injury. Am J Surg 187(3):338–342CrossRef

19.

Brinson GM, Senior BA, Yarbrough WG (2004) Endoscopic management of retained airgun projectiles in the paranasal sinuses. Otolaryngol Neck Surg 130(1):25–30. https://doi.org/10.1016/j.otohns.2003.07.010CrossRef

Title: Orbito-Cranial Gunshot Injuries with Retained Sinonasal Bullets
Authors: Gerrit Viljoen
Sean Tromp
Nicholas Goncalves
Patrick Semple
Darlene Lubbe
Publication date: 01-12-2021
Publisher: Springer India
Keywords: Frontobasal Fracture
Meningitis
Frontobasal Fracture
Published in: Journal of Maxillofacial and Oral Surgery / Issue 4/2021
Print ISSN: 0972-8279
Electronic ISSN: 0974-942X
DOI: https://doi.org/10.1007/s12663-020-01365-4

At a glance: The STEP trials

Springer Medicine

Orbito-Cranial Gunshot Injuries with Retained Sinonasal Bullets

Abstract

Introduction

Aims

Patients and methods

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Aims

Patients and methods

Conclusion

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