Dissecting firearm injury to the head and neck with non-linear bullet trajectory: A case report

Arc-like curvilinear bullet pathways along inner surface of skull - two cases

To provide example cases within the peer-reviewed literature of a phenomenon related to certain gunshot wounds of the head where the bullet pathway courses along the inner table of the skull. Presentation of two cases discovered at medicolegal autopsy. The two cases provide radiologic and autopsy demonstration of bullet pathways within the head where the projectiles track along the inner aspect of the cranium, in a circumferential manner, such that the bullets are recovered in a location on the opposite side of the brain/head, with no projectile pathway within the intervening deep structures of the brain. The cases provide photographic and radiologic autopsy documentation of the phenomenon, which is described in forensic pathology textbooks and rare peer-reviewed literature sources, but without photographic demonstration. Recognition of this phenomenon in the clinical setting, or when correlating autopsy external and radiologic findings with historical information, may provide an explanation for situations where immediate incapacitation does not occur following a gunshot wound of the head.

Unusual Migration of Bullet from the Right Scalp to Left Pyriform Fossa

Spontaneous migration of a retained bullet is rare. Foreign bodies like bullets will be found at the distant site from the region of wound of entry in case they migrate. We report a case of a 17-year-old female with spontaneous migration of bullet from right temporo- parietal scalp to the posterior wall of left pyriform fossa. Twelve years back she had received a gunshot in right temporal region, no exploration was done to remove the bullet. She started complaining of discomfort in the upper neck of two months duration. Rigid laryngoscopy revealed smooth bulge with thinning of overlying mucosa. Radiographs of the neck showed bullet along the posterior pharyngeal wall in the region of the pyriform fossa. CT scan of the head and neck region was done to exclude the presence of any other foreign bodies. Microlaryngoscopy suspension of the larynx was done and CO2 laser was used to incise the mucosa over the bullet and it was retrieved with the help of long artery forceps. Our case illustrates that bullets may take an unexpected course from the site of entry, probably by migration. Trans oral CO2 laser microsurgery is the recommended approach for removal of such foreign bodies.

Gunshot Injury to the Face With Atypical Non-linear Bullet Trajectory: A Case Report

The disruptive effect of firearm missiles on body tissues depends on many factors. However, it mainly relates to the bullet's physical and dynamic properties and tissue-related factors. We encountered an unusual case of a gunshot injury wherein the bullet traversed the neck with an upward and non-linear trajectory with an exit from the contralateral side of the neck without damaging any vital neck organs. A 26-year-old male presented with a gunshot wound to the chin from close range. A bullet entry hole was observed on the right side of the chin, encircled by the abrasion collar, with tattoo marks around the area. The patient was conscious, with normal vital signs and no injury to the cranial nerves or aerodigestive tract. The CT imaging of the patient revealed the injury tract traversing through the muscles of the floor of the mouth to involve the left carotid and left parapharyngeal space, along with the left sternocleidomastoid muscle, with an exit hole below the left mastoid in the posterior triangle of the neck. A bullet usually travels through the body in a straight line or pathway; however, its non-linear trajectories depend on the projectile's dynamics and its interaction with the body tissues. The present case emphasizes understanding wound ballistics to know the erratic bullet trajectories in the victim's body and their interpretation, irrespective of their entry site.

Ferimentos por arma de fogo em profissionais de segurança pública e militares das forças armadas: revisão integrativa

Resumo Objetivo: sistematizar a produção bibliográfica sobre a ocorrência de ferimentos por arma de fogo (FAF) entre profissionais de segurança pública, incluindo policiais e militares de forças armadas. Métodos: revisão integrativa realizada em bases bibliográficas eletrônicas brasileiras e internacionais (BVS, Scopus, Web of Science e Pubmed), sem estipulação de recorte temporal ou territorial. Resultados: foram encontrados 31 artigos segundo os critérios de inclusão e de exclusão. Notou-se aumento crescente de publicações entre 1976 e 2016, a maioria publicada em inglês, em periódicos da área da saúde. Os FAF foram o principal mecanismo de injúria em serviço entre os policiais, mais frequentes entre profissionais do sexo masculino, na faixa etária de 30 anos. As circunstâncias de maior risco foram: ações de prisão e confrontos com criminosos; respostas a chamados policiais para verificação de perturbação à ordem; e em situações de guerra. Existem poucos estudos que discutam as repercussões físicas dos FAF para o exercício profissional dos trabalhadores de segurança pública.

An Unusual Bullet Trajectory: Entered Through the Face and Ended Up in the Neck

The authors describe a case of gunshot injury in a 26-year-old male patient with an unusual bullet trajectory. The bullet had an entry hole just near the right lateral alar cartilage of the nose, and the trajectory descended through the left side of the neck by route of the hard palate, soft palate, and posterior pharyngeal wall, respectively. Surgical removal of the bullet was achieved with neck exploration. Gunshot injuries of the head and neck necessitate a thorough clinical and radiological evaluation due to the possibility of an unusual bullet trajectory.

Ballistic Reconstruction of a Migrating Bullet in the Parapharyngeal Space

A 21-year-old male suffering from severe throat pain after being hit by a bullet in Syria claimed that he was shot through his eye and that the bullet subsequently descended behind his throat. Even though the first medical report stated that this course is implausible, meticulous workup provided evidence that the bullet might have entered the parapharyngeal space in a more cranial position than the one it was found eight months later. Our case highlights that bullets are able to move within the body, rendering ballistic reconstruction difficult. However, after removal of the bullet the patient's symptoms completely resolved.