Management of penetrating medial and retro-bulbar orbital shrapnel/bullet injuries

Gun-related eye injuries: A primer

Gun-related eye injuries are relatively common in the context of gunshot wounds to the head and neck. Many of the fundamental principles of gunshot wound management apply to the care of these patients, but the complex anatomy and functional relationships of the periocular region do pose special challenges. We provide a focused primer for physicians seeking a more in-depth understanding of gun-related eye injuries and present 3 representative cases outlining the spectrum of pathology, provide a focused review of the relevant ballistics concepts, and discuss the management of injuries to the periocular soft tissues, orbital structures, and globe. We found that good cosmetic and functional results can often be achieved with appropriate early intervention, but visual prognosis may remain guarded despite optimal treatment.

Expanding Hematoma's Life-Threatening Neck and Face Emergency Management of Ballistic Injuries

This article aims to bring attention to the morbidity and fatality of hemorrhage, how expanding hematoma and air compromise neck/face N/F injuries and present challenges. Large neck vessel ballistic injuries may lead to hemorrhage and expanding hematoma, resulting in airway compromise, due to injuries to the internal and/or external carotid arteries, internal jugular veins "internal carotid artery, external carotid artery, internal jugular vein," and the external carotid artery deep branches. This also leads to injuries to the cervical fascial layers (barriers of deep spaces) that facilitate pooling blood and hematoma into compartmental and large potential space which effects the pharynx, larynx, esophagus, and trachea.The expanding hematomas distort neck anatomical landmarks so "no neck zones" classifications are applicable. As the spectrum of injuries continues to evolve, the clinical characterization needs a new categorization based on compartmental hematoma and potential space anatomical location like retropharyngeal, parapharyngeal, sublingual, submandibular spaces, retrobulbar, and cheek compartment space hematomas.Presence of symptoms and location of the hematoma generally dictate what type of procedure is needed and how urgently it needs to be appropriately performed.Two unusual patients of pseudoaneurysms facial artery injuries with extravasation of blood producing a pulsating hematoma are referred to. Another patient considers large internal carotid artery injuries pseudoaneurysms revealed in angiography.The immediate management of life-saving patients requires aggressive airway maintenance at the scene, conscious victim will often obtain a posture that clears his airway and the semiconscious or unconscious put him in prone position. Air compromise may need emergency intubation, large bore cannula cricothyroidotomy, cricothyrotomy and at medical facilities tracheostomy.

Temporal Approach to Removal of a Large Orbital Foreign Body

Accidents with firearms can result in extensive orbital trauma. Moreover, gun parts can come loose and impale the maxillofacial region. These injuries can cause the loss of visual acuity and impair eye movements. Multidisciplinary treatment is required for injuries associated with this type of trauma. Computed tomography with three-dimensional reconstruction is useful for determining the precise location and size of the object lodged in the facial skeleton, thereby facilitating the planning of the correct surgical approach. The temporal approach is a fast, simple technique with few complications that is indicated for access to the infratemporal fossa. This article describes the use of the temporal approach on a firearm victim in whom the breech of a rifle had impaled orbital region, with the extremity lodged in the infratemporal fossa.

Ultrasonographically supported removal of foreign bodies of the eye lid and parapharyngeal space in a 13-year-old boy subjected to shot injuries in early childhood

Background: B-scan ultrasonography is widely used in diagnostics of head and neck pathologies. Ultrasonography can be applied intraoperatively to identify foreign materials.

Case report: This case report describes the ultrasonographic identification of foreign bodies of the eye lid and parapharyngeal space in an adolescent who was injured several years ago, obviously a victim of domestic violence. B-scan ultrasonography (small part transducer, emission frequency: 7.5 MHz) proved to be a reliable tool to locate the foreign bodies. Ultrasound imaging facilitated the decision-making of the surgical approach and thus reduced the surgical exploration time.

Discussion: B-scan ultrasonography is a valuable tool in oral and maxillofacial surgery. The use of B-scan ultrasonography in the head neck region requires the capacity of the surgeon to fuse the ultrasonographic picture with the topography of the head and neck. The advantages and limitations of B-scan ultrasonography in the head and neck region concerning foreign body identification are briefly discussed.