[Gunshot injuries in the head-neck area--basic principles, diagnosis and management]

Abstract

Bullet wounds are a rare occurrence during times of peace. Recently, however, there has been a general increase in the number and severity of this type of trauma in our case load. First, the possible firearms and the individual types of ammunition will be discussed. Based on this background, the possible types of wounds are presented. Principally, one distinguishes ricocheting shots from grazing ones, and those leaving bullets lodged in the body from those with perforating wounds. The extent of tissue damage depends on internal lacerations, on the compression of the tissue and on the temporary cavitation along the projectile path. In contrast to other types of injuries, which are caused by a blow or impact to the face or skull, gunshot traumas are characterized by an irregular path, as well as, by localized destruction of bones with associated effects. In this connection, the severity of the bullet wound also depends upon the extent of involvement of the viscerocranium. As causes of gunshot wounds during times of peace, suicidal intent, the negligent handling of firearms and especially brutal crimes are those which come into consideration first and foremost. The diagnostic aspect of firearm wounds, beside anamnesis, comprises comprehensive X-ray diagnostics for a complete picture. From the therapeutic side, tetanus serum and antibiotics as a prophylactic are recommended initially. The operative treatment should take place depending on the injury with the removal of a possible projectile. Bullet wounds always require an interdisciplinary approach to treatment.