Bullet removal from the infratemporal fossa

Abstract

War injuries are the cornerstone of maxillofacial surgery, and it led to the initiation and development of this specialty, and each case represents a challenge to the surgeon who deals with it. In this article, we present a 30-year-old male patient who was referred to our emergency department complaining of gunshot wound, severe pain, and limitation in mouth opening. Preoperative imaging showed a bullet with a very long path lodged in the infratemporal fossa. Three different approaches with the aid of C-arm imaging system were used for the removal of this bullet; the last approach was the successful one.

Keywords: C-arm scanning; gunshot wounds; infratemporal fossa approach; missile injuries.

Figure 1

Posterior-anterior radiograph

Figure 2

Open and closed mouth lateral radiograph

Figure 3

Computerized tomography

Figure 4

Missile injury, perforating type

Figure 5

Missile injury, avulsive type

Figure 6

Missile injury, penetrating type

Figure 7

The path of the bullet

Figure 8

The approaches

Figure 9

Marking preauricular with temporal extension approach

Figure 10

Temporalis muscle reflection to expose temporal and infratemporal fossa, also the lateral eyebrow approach can be seen

Figure 11

Bullet localization intraoperatively by portable imaging system (C-arm)

Figure 12

Bullet removal

Figure 13

Wound closure and drain insertion