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Gunshot injury to the face with a missile lodged in the upper cervical spine without neurological deficit

M Bumbairevi¹, A Lei¹, V Bumbairevi², Z Rakoevi³ and M Djuri^*,4

¹ Institute for Orthopaedic Surgery and Traumatology, University Clinical Centre, Viegradska 26, 11000 Belgrade, Serbia; ² Institute for Anesthesiology and Intensive Care, University Clinical Centre, Belgrade, Viegradska 26, 11000 Belgrade, Serbia; ³ Department of Radiology, Dental School, University of Belgrade, Rankeova 6, 11000 Belgrade, Serbia; ⁴ Department of Anatomy, Medical Faculty, University of Belgrade, Dr Subotia 4/2, 11000 Belgrade, Serbia

*Correspondence to: Prof. Marija Djuri, Department of Anatomy, Medical Faculty, University of Belgrade, Dr Subotia 4/2, 11000 Belgrade, Serbia; E-mail: marijads{at}eunet.yu

Received 3 January 2005; revised 2 May 2005; accepted 14 June 2005

An unusual case of facial gunshot injury with the missile lodged in the cervical spinal canal, but without any neurological impairment is reported. The extent of tissue damage and missile track termination in a male patient who sustained gunshot trauma to the face was assessed by plain radiography and by CT scans. The patient was treated conservatively and observed for clinical manifestations of neurological deficit for 3 weeks. CT of the head and neck performed 13 years after injury with the three-dimensional (3D) reconstruction of skeletal elements revealed healed fractures of the right nasal bone, the labyrinth of the right ethmoid bone, and position of the missile on the medial aspect of the right lateral mass of the atlas. There was no migration of the missile during this period. This case report of gunshot wound to the face associated with injury of the cervical spine indicated possibility of survival and atypical absence of clinical manifestation that may occur even when a bullet remains in the spinal canal.

Keywords: gunshot; face; spine injury; treatment