Endoscopic removal of bullets from the cranial ridge junction region via transoral and transnasal approaches: Two case reports and review of literature

Abstract

Endoscopes in otolaryngology may facilitate accessing the lumens and sites such as upper cervical spine with minimally invasive surgical exposure. Here, we present 2 interesting cases of youth who underwent endoscopic removal of bullets in the cranial ridge junction region.The first case was a 20-year-old young man who underwent a gunshot in the face. A CT scan showed that a metallic foreign body located inside the right lateral body of Atlas that presented a comminuted fracture. The second case a 36-year-old man who also underwent a gunshot in the face. CT scan showed a foreign body lodged in the soft tissues before the right anterior arch of Atlas cone (C1) that presented a fracture. The bullets in these 2 patients were removed under the endoscopes with minimal damage, respectively. The patients were discharged without neck activity obstacle.The advantage of endoscopic technique is obvious because limited visualization does not damage surrounding tissues, thus decreasing surgical complications. This was an interesting experience of surgical operation in this region.

Figure 1

The first case: (A) axial CT scan showed that a metallic foreign body located inside the right lateral body of Atlas that presented a comminuted fracture, but has not entered into the vertebral canal; (B) sagittal CT scan showed that the bullet was located at the cranial ridge junction region; (C) the removed bullet (the arrows show the location of the bullet). CT = computed tomography.

Figure 2

The second case: (A) sagittal CT scan showed that the bullet was located at the cranial ridge junction region; (B) intraoperative image of the bullet under the endoscopy. (C) sagittal CT scan confirmed the removal of the bullet (the arrows show the location of the bullet). CT = computed tomography.