Inchingolo Francesco, Tatullo Marco, Marrelli Massimo, Inchingolo Alessio D, Pinto Giorgia, Inchingolo Angelo M, Dipalma Gianna
Department of Dental Sciences and Surgery, University of Bari, Bari, Italy.
Int J Surg Case Rep. 2011;2(8):272-4. doi: 10.1016/j.ijscr.2011.08.009. Epub 2011 Sep 7.
Portable firearms have a relevant medico-legal interest, being a major cause of injury. Bullet entry wounds generally have a particular appearance, including contusion, skin introflection, and simple or excoriated ecchymosis. The skin wound is typically a hole with frayed margins, whose diameter is smaller than that of the bullet.
We report the case of a 19-year-old man with ballistic trauma. Examination of the patient's lesions indicated that the bullet had entered from the left mandibular parasymphysis, creating a small hole without the typical bullet wipe and blackening. Subsequently, the bullet seemed to have fractured the left chin region immediately below the lower alveolar process, and it finally stopped in the submandibular area in the suprahyoid region of the neck.
This case is peculiar because the distinctive features of a firearm injury were absent; the lack of bleeding and edema made the case difficult to interpret without additional diagnostic investigations.
Ballistic trauma can manifest in different ways; therefore, internal trauma should be suspected even in the absence of clear external signs. This case report shows how an unusual bullet entry hole can mask quite serious injuries.
便携式枪支具有重大的法医学意义，是造成伤害的主要原因。子弹入口伤通常具有特殊外观，包括挫伤、皮肤内翻以及单纯或擦破的瘀斑。皮肤伤口通常是一个边缘磨损的洞，其直径小于子弹直径。
我们报告一例19岁男性弹道伤病例。对患者损伤的检查表明，子弹从左下颌骨联合处进入，形成一个小孔，没有典型的子弹擦痕和变黑现象。随后，子弹似乎立即在下牙槽突下方的左下巴区域造成骨折，最终停留在颈部舌骨上区域的下颌下区。
该病例较为特殊，因为缺乏火器伤的典型特征；没有出血和水肿，使得在没有额外诊断检查的情况下难以解释该病例。
弹道伤可表现为不同形式；因此，即使没有明显的外部体征，也应怀疑有内部创伤。本病例报告显示了一个不寻常的子弹入口孔如何掩盖相当严重的损伤。
