Firearm Injury in Face: A Case Report

Introduction: Firearms injuries (FI) on the face usually cause great inconvenience to patients and physicians for the noble structures present; the difficulty in managing bleeding nasal, oral, facial, and airway maintenance; besides the possible esthetic and functional sequelae, corroborating high mortality and morbidity.

Objectives: This article describes a case of FI occurred in polytrauma unit of the Hospital de Base do Distrito Federal (HBDF), Brazil.

Case report: A 19-year-old male patient, victim of FI in the face 2 hours ago, hemodynamically stable, admitted to the ENT unit of HBDF. He presented orifice of entry into branch of the right mandible, no exit hole, trismus, moderate bleeding in the right tonsil, and swelling of the retromolar trigone and cheek. He also presented neck pinjury or pain.

Result: Tomography showed bone fragments in the lingual region and masticatory space right next to tooth 48 and comminuted fracture of mandible transfixation projectile fragments before the C2 region. The team of oral and maxillofacial surgery removed bone fragments and tooth 48. Cervical Doppler showed carotid and jugular without injury. The patient kept bleeding, developed somnolence, and initiated shock protocol. He opted for surgical intervention. There was extensive laceration of the soft palate, anterior, and posterior pillar, and amygdala lacerated with moderate bleeding. The resection of the amygdala was preceded with cauterizing and suturing the pharyngeal muscles with the removal of prevertebral projectile. The patient evolved with oropharyngeal pain and odynophagia without oral bleeding.

Conclusion: Thirty days follow-up showed good healing without dysphagia or food to reflux nose, mild speech impairment with dysarthria, and referred for speech rehabilitation.