1/21. Intra- and perioral shooting fatalities.Determination of the manner of death in the case of intra- and perioral firearm wounds can be difficult especially if death scene investigation is unclear and inadequate. In this study, we investigated some characteristics of these firearm wounds which were autopsied in Istanbul. During the 5-year period from 1991 through 1995, there were 15 intra- and perioral firearm fatalities investigated. In all the cases, only one shot was fired into the mouth. They constituted 1% of all the firearm fatalities. The mean age of the victims was 27 years and males constituted 73.3% of the victims. Most of the wounds were caused by handguns. Homicides accounted for 53.3% of these deaths. Three of 15 cases could not be identified as intraoral firearm wounds by general practitioners during the scene investigations.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
2/21. Gunshot wound of the atlas in a youth.The case of a bullet retained, without causing neurological symptoms, in the anterior arch of a youth's atlas after a gun had been fired a short distance from his mouth is reported. The patient was managed with external stabilization.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
3/21. death due to accidentally self-inflicted gunshot wound.A 37-year-old man, with the entrance gunshot wound on the front of the right leg several cm above the knee, was found dead at home in his bed. No other lesions were observed except a contusion ring around the wound that spread downward and to the right. On autopsy, the wound path was followed upward from the entrance wound (0.7 cm in diameter). The bullet went through the medial aspect of the quadriceps and adductor muscles and continued upward, adjacently to the internal iliac artery, perforating the pelvic floor and the median lobe of the prostate. It passed by the left kidney, injuring its fatty capsule, then went through the mesentery near the left segment of the transverse and descending colon, and entered the thoracic cavity through the diaphragm, injuring the posterior wall of the pericardium and the posterior wall of the left ventricle at the level of the first left rib. The bullet was found in the apex of the left lung. death was caused by cardiac tamponade.- - - - - - - - - - ranking = 1.1380118041623keywords = floor (Clic here for more details about this article) |
4/21. A mouthful of trouble.The prehospital providers in this case performed a thorough and detailed assessment. They searched for and found a puncture wound in the posterior buccal region, and learned the patients was also hypoglycemic, with a history of diabetes, and insulin-dependent. It was not clear how the patient arrived at a hypoglycemic state, or if he had suffered a seizure. After the family arrived at the hospital and went to the patient's home, they determined the circumstances that caused this unusual presentation: The patient was the victim of a home-invasion robbery and had been shot in the mouth with a small-caliber weapon. The home invasion had taken place approximately 12 hours prior to the victim being found. The victim had been knocked unconscious by the force of the shot, although the bullet did not break any bones. He had not eaten prior to the shooting. Upon arrival at the ED, a small exit wound was noted behind the patient's left ear--hair and dried blood had obscured it from the prehospital providers. However, the providers did alert the ED physician to the buccal puncture wound, which enabled the physician to consider the possibility that the mouth wound was the result of a gunshot. Gunshot wounds are unpredictable in their damage patterns and effects on their victims. They might lead a patient to become hemodynamically unstable, but that was not the case here. Hemodynamic stability should not preclude the consideration of traumatic insult throughout your assessment. The initial presentation of this patient may have tempted EMS to pursue the suspicions stated by the neighbor at the scene (seizure), but a detailed assessment provided the information necessary to treat the man appropriately.- - - - - - - - - - ranking = 6keywords = mouth (Clic here for more details about this article) |
5/21. Elevated blood lead resulting from maxillofacial gunshot injuries with lead ingestion.PURPOSE: The purpose of this study was to identify the contribution of ingested lead particles to elevated blood lead concentrations in victims of gunshot injury to the maxillofacial region. patients AND methods: As part of a larger study of the effects of retained lead bullets on blood lead, a retrospective review of study findings was completed on 5 of 8 patients who sustained injuries to the maxillofacial region. These 5 patients were recruited into the larger study within 11 days of injury and showed a penetration path for the projectile that engaged the upper aerodigestive tract. All subjects were recruited from patients presenting for care of their gunshot injuries to a large inner-city trauma center with a retained bullet resulting from a gunshot injury. An initial blood lead level was measured for all recruited patients and repeated 1 to 17 weeks later. Medical history was taken along with a screening and risk factor questionnaire to determine other potential or actual sources (occupational/recreational) of lead exposure. (109)Cd K-shell x-ray fluorescence determinations of bone lead were completed to determine past lead exposure not revealed by medical history and risk factor questionnaire. Radiographs taken of the abdomen and chest, required as a part of the patient's hospital care, were retrospectively reviewed for signs of metallic fragments along the aerodigestive tract. RESULTS: All 5 patients retained multiple lead pellets or fragments at the site of injury, sustained fractures of the facial bones, and showed increases in blood lead. Three of the 5 study subjects who sustained maxillofacial gunshot injuries involving the mouth, nose, or throat region showed metallic densities along the gastrointestinal tract indicative of ingested bullet fragments. Each patient with ingested bullet fragments showed rapid elevation of blood lead exceeding 25 microg/dL and sustained increases well beyond the time when all ingested fragments were eliminated. A 3-year follow-up on these 3 patients showed significantly sustained elevation of blood lead but less than that observed during the initial 6 months after injury. None of the 5 study subjects showed any evidence of metallic foreign bodies within the tracheobronchial regions indicative of aspiration. CONCLUSION: Ingestion of lead fragments can result from gunshot injuries to the maxillofacial region and may substantially contribute to a rapid increase in blood lead level. Prompt diagnosis and elimination of ingested lead fragments are essential steps necessary to prevent lead being absorbed from the gastrointestinal tract. Increased blood lead in victims after gunshot injuries must be fully evaluated for all potential sources, including recent environmental exposure, absorption of lead from any remaining bullets in body tissues, and the possibility of mobilization of lead from long-term body stores such as bone.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
6/21. Planned complex suicide. Report of two autopsy cases of suicidal shot injury and subsequent self-immolation.Two cases of planned complex suicide are presented. In both cases, the suicidal persons shot themselves after making sure that in the sequel their bodies would be burnt. In the first case, a 65-year-old man had shot himself in the mouth and consequently fell into a fire he had lighted before. In the second case, a 43-year-old man set fire to his flat and shot himself directly afterwards. On the basis of the reported cases, a short literature review on planned complex suicides is given.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
7/21. Pharyngolaryngeal migration: a delayed complication of an impacted bullet in the neck.We present a case of a patient who sustained a bullet wound to the mouth and face resulting in impaction of the foreign body in the neck. This was initially managed conservatively until migration into the supralaryngeal area occurred. This resulted in airway obstruction, dysphagia, and dysphonia necessitating resuscitation and per-operative intrapharyngeal removal. Bullet wounds are uncommon in this country and experience with these cases is lacking. This paper discusses the various management options and the mechanism of how the bullet became lodged in the tissues of the neck.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
8/21. Superselective embolization for control of facial haemorrhage.A case on the successful management of acute facial bleeding from the maxillary artery by superselective embolization is described. A 26-year-old male sustained a gunshot wound (GSW) to the face leading to profuse bleeding from the site of bullet entry, the nose and the mouth. Local measures failed to arrest the bleeding. The patient was stabilised haemodynamically, then the source of bleeding was located by angiography and the bleeding was arrested by superselective embolization.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
9/21. Simultaneous reconstruction of large maxillary and mandibular defects with a fibular osteocutaneous flap combined with an anterolateral thigh flap.This article reports the simultaneous reconstruction of maxillary and mandibular defects caused by a close-range gunshot blast to the face with one fibular osteocutaneous flap combined with an anteroateral fasciocutaneous flap. A fibular osteocutaneous flap was used for both mandibular and maxillary defects, using multiple osteotomies and discarding a central bony segment and an oral floor defect. An anterolateral thigh flap was used to cover a three-dimensional defect of both the intraoral mucosal region, as well as external skin and soft tissue defects, including some on the upper and lower lips. The results demonstrated that the method was a good choice in the reconstruction of large composite facial defects, both aesthetically and functionally.- - - - - - - - - - ranking = 1.1380118041623keywords = floor (Clic here for more details about this article) |
10/21. Endovascular management of exsanguinating vertebral artery transection.BACKGROUND: vertebral artery (VA) transection is a rarely described entity that may present dramatically with a life-threatening external hemorrhage. CASE DESCRIPTION: A 25-year-old man that was victim of a terrorist attack presented a gunshot wound to the mouth with massive bleeding. The bullet perforated the oropharynx and injured the right VA. Combined antegrade and retrograde endovascular embolization by means of detachable coils allowed rapid control of the bleeding. CONCLUSION: Bleeding related to VA transection can be managed safely by means of endovascular combined approaches.- - - - - - - - - - ranking = 1keywords = mouth (Clic here for more details about this article) |
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