Armed Forces Trauma Center, Armed Forces Capital Hospital, Seongnam-si.
Department of Plastic Surgery, Inha University College of Medicine, Incheon, South Korea.
J Craniofac Surg. 2022 Sep 1;33(6):e573-e576. doi: 10.1097/SCS.0000000000008508. Epub 2022 Feb 3.
The authors report a case of a soldier who survived after shooting a blank round from a K2 rifle into the oral cavity.For committing suicide, a 22-year-old male soldier shot a K2 rifle into his oral cavity. Because the first shot was a blank fire, he received an injury to his oral cavity, especially to his palate. On arrival hospital via air evacuation, the patient's vital signs were relatively stable and Glasgow Coma Scale score was 15. Profound epistaxis was noted from both nostrils, and his mouth was filled with blood. Intubation was performed immediately, followed by tracheostomy. On computed tomography scan, the palate was injured and laryngeal edema was seen.On operative field, severe swelling of the larynx was observed. Gunpowder remained present throughout nearly the entire palate. His palate was burned, and there was a 3-cm-diameter mucosal defect. The bleeding point was cauterized, and bleeding was controlled using oral packing. The packing was changed every morning for the first 2 days, and finally removed on the third day of hospitalization. On the eighth day of hospitalization, the defect of his soft palate showed healing by secondary intention, and a planned reconstructive operation was not needed. Tracheostomy was removed on the 45th day. He was able to eat and speak at the time of discharge (93rd day).The authors cannot overemphasize the importance of the airway in oral injuries. Packing for bleeding control under a safe airway should be followed as a routine part of the protocol for similar cases.
作者报告了一例士兵用 K2 步枪向口腔内发射空包弹后幸存的案例。为了自杀，一名 22 岁的男性士兵将 K2 步枪射入口中。由于第一枪是空包弹，他的口腔受伤，尤其是上颚受伤。通过空中后送抵达医院时，患者的生命体征相对稳定，格拉斯哥昏迷评分（Glasgow Coma Scale）为 15 分。双侧鼻腔有明显鼻出血，口腔充满血液。立即进行插管，随后进行气管切开术。计算机断层扫描（CT）显示上颚受伤，喉部水肿。手术野观察到严重的喉部肿胀。几乎整个上颚都残留有火药。上颚烧伤，有 3 厘米直径的黏膜缺损。烧灼出血点并用口腔填塞止血。前 2 天每天早上更换填塞物，第 3 天住院时取出。住院第 8 天，软腭的缺损通过二期愈合，无需计划进行重建手术。第 45 天拔出气管套管。患者在出院时（第 93 天）能够进食和说话。作者不能过分强调口腔损伤中气道的重要性。在安全气道下进行出血控制填塞应作为类似病例治疗方案的常规部分。
