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. 2014 Aug;63(4):378-81.
doi: 10.7727/wimj.2013.260. Epub 2014 Jun 25.

Gunshot-caused Facial Injury Combined with Lower Cervical Spine Injury: A Case Report

J Wang  1 , C Y Ye  1 , M Y Zhu  1 , J D Yuan  1 , H L Ten  2
Affiliations

Gunshot-caused Facial Injury Combined with Lower Cervical Spine Injury: A Case Report

J Wang et al. West Indian Med J. 2014 Aug.

Abstract
in English, Spanish

A 32-year old male patient was wounded by a pistol. As shown in computed tomography (CT) scanning images, there was comminuted fracture of the left mandible and the bullet was found in the left side behind the sixth cervical vertebra. After the patient was hospitalized, the debridement was done in the emergency room and the operation of open reduction and internal fixation for comminuted fracture of left mandible was performed successfully. Eighteen days later, the patient was taken to surgery for anterior cervical decompression and fusion with autogenous iliac bone grafting for the sixth cervical vertebra. Postoperative follow-up of the patient over two years indicated that the left biceps muscle strength was recovered to level 4. Gunshot wound to the face associated with injury of the low cervical spine has the possibility of survival. It is safe to treat facial wounds early in the patient's treatment course, even if the bullet remains in the cervical vertebral body and there is neurological function damage.

Un paciente masculino de 32 años fue herido por un disparo de pistola. Como se muestra en las imágenes escaneadas de la tomografía computarizada (CT), se produjo una fractura conminuta de la mandíbula izquierda, y la bala fue encontrada en el lado izquierdo detrás de la sexta vértebra cervical. Después de que el paciente fuera hospitalizado, se realizó un desbridamiento en la sala de urgencias, y se llevó a cabo con éxito la operación de reducción abierta y la fijación interna de la fractura conminuta de la mandíbula izquierda. Dieciocho días más tarde, el paciente fue llevado a cirugía para una descompresión cervical anterior y una fusión con injerto óseo autógeno del ilíaco para la sexta vértebra cervical. El seguimiento postoperatorio del paciente durante dos años, indicó que la fuerza muscular del bíceps izquierdo del paciente se recuperó hasta el nivel 4. Una herida de bala en la cara asociada con una lesión de la columna cervical inferior tiene posibilidad de supervivencia. Es seguro tratar las heridas faciales temprano en el curso del tratamiento del paciente, incluso si la bala aún permanece en el cuerpo vertebral cervical y hay daño de la función neurológica.

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Figures

Fig. 1
Fig. 1. Computed tomography (CT) scanning images (3D reconstruction): comminuted fracture of the left mandible.
Fig. 2
Fig. 2. Computed tomography (CT) scanning: the bullet was found in the left side behind the sixth cervical vertebrae, part of which protruded into the spinal canal and caused fracture to part of the left pedicle.
Fig. 3
Fig. 3. Debridement and open reduction and internal fixation for the left mandible were performed successfully. The oesophageal angiography found no significant injury to the oesophagus, and the bullet was about 14 mm from the posterior border of the oesophagus.
Fig. 4
Fig. 4. The patient had surgery for anterior cervical decompression. Black arrow indicates the position of the bullet.
Fig. 5
Fig. 5. The bullet after it was removed.
See this image and copyright information in PMC

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