Ibn El Jazzar Faculty of Medicine, The University of Sousse, Sousse, Tunisia.
Forensic Medicine Department, Ibn El Jazzar University Hospital, Kairouan, Tunisia.
Tunis Med. 2024 Aug 5;102(8):500-503. doi: 10.62438/tunismed.v102i8.5045.
Facial gunshot wounds have devastating functional and aesthetic consequences for the patient. If associated with penetrating craniocerebral injuries, the prognosis is rather compromised even with appropriate medical and surgical treatment. Chop-off injuries with penetrating wounds constitute a challenging situation for the facial reconstructive surgeon in facial trauma.
This case involved a 49-year-old man who sustained an accidental facial shot from a pellet gun. Radiological and clinical investigations revealed complex ballistic trauma to the maxillofacial region, with projectiles reaching the base of the skull. One of the projectiles migrated via the carotid canal towards a cerebral artery, leading to obstruction of the artery with cerebral infarction. An autopsy was performed which evaluated that the shooting distance was compatible with a long distance, causing the dispersion of lead grains with the absence of a wad inside the trauma site.
In some cases of facial gunshot wounds, despite a complex and extensive lesion assessment, death may occur due to a neurological complication rather than sustaining hemodynamic shock, depending on the trajectory of the projectiles.
面部枪伤会给患者带来严重的功能和美观后果。如果与穿透性颅脑损伤相关，即使经过适当的医疗和手术治疗，预后也相当差。对于面部创伤的面部重建外科医生来说，切断伤伴穿透伤构成了一个具有挑战性的情况。
本例涉及一名 49 岁男性，他因意外面部被气枪射伤。影像学和临床检查显示颌面区域存在复杂的弹道创伤，弹丸到达颅底。其中一个弹丸通过颈动脉管向大脑动脉迁移，导致动脉阻塞和脑梗死。进行了尸检，评估结果表明，射击距离与远距离相兼容，导致铅粒分散，创伤部位内没有弹丸。
在某些面部枪伤的情况下，尽管对复杂和广泛的损伤进行了评估，但由于弹丸的轨迹，可能会因神经并发症而死亡，而不是因发生失血性休克而死亡。
