[Diagnostic and therapeutic problems in gunshot wounds].

BACKGROUND

Bullet wounds are a rare occurrence during times of peace. Recently, however, there has been a general increase in the relative number and severity of this type of trauma. In times of peace, gunshot wounds may be mainly caused by suicide attempts, negligent handling of firearms and especially violent conflicts. Bullet wounds, in contrast to wounds caused by a blow or impact to the viscerocranium, are characterised by an irregular path, entry and exit wounds, as well as localised demolition of bones with the associated defects.

PATIENTS

30 patients with gunshot wounds were treated during the past 35 years. Basing on four case reports, problems of interdisciplinary treatment approach to gunshot wounds are discussed, as well as the diagnostic and therapeutic consequences.

RESULTS AND CONCLUSIONS

The first case concerns a retained missile in the left fossa pterygopalatina. Intraoperative removal caused a rupture of the A. maxillaris. Preoperative angiography could have provided valuable information. In the second case, an injury caused by a shot from a blank cartridge pistol in the left facial area resulted in extensive wounds with several surgical revisions. The third case was a shot injury to the tongue with an unexpected wound and bleeding. The fourth case describes a child with a bullet in a hyperplastic adenoid tonsil. Primary careful treatment is of greatest significance for functional and cosmetic results due to extensive rupturing and wounds.