We present a case of an 18 year old man from Los Se 12 de Octubre Hospital in the SAMUR, after suffering a bull horn wound in the left cervicofacial region San Rebastibas 2005.
An imminent transfer to the operating room was made, showing the correct orotracheal intubation that had been carried out in situ by the health personnel of the bullet.
The absence of respiratory and cardiovascular alterations and a stable hemodynamic situation were verified.
Then, under general anesthesia, a regulated thoracotomy and central and peripheral line placement are performed.
Subsequently, an initial and diagnostic exploration was performed, which showed a contuse and anfractuous wound from the upper left supraclavicular region to the ipsilateral labial commissure.
The existence of a fracture of the right mandibular body, comminuted fracture of the left mandibular angle, dental avulsion of the incisal sector of the upper jaw, as well as severe laceration of the lingual muscles and floor of mouth was objectified.
Also, there is an exposure of the left jugular-carotid bundle checking its total integrity.
Objective cervical interfacial suture is performed at the level of the fracture focus and adjacent soft tissues, with the aim of temporarily restoring the anatomy, and preserving the patient's brain damage to the Central Radiofacial Service.
Subsequently, once in the operating room, direct laryngoscopy was performed, ruling out the presence of laryngoesophageal lesions.
Methicillin washed with surgical brush and antiseptic solution of the entire oral cavity and affected tissues.
Anti-tetanus vaccine and gammaglobulin were administered, and intravenous systemic treatment with amoxicillin-clavulanic acid and metronidazole was initiated.
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After a correct exposition of the fracture foci at the level of the right mandibular body and left mandibular angle given the presence of surgical Synthesis in the presence of the characteristics of the wound, reduction and high osteothesitis was performed using plates of mandibular reconstruction with 2.4.
The extraction of remaining root remains in the upper incisor sector and corresponding bone regularization were performed.
Suture and anatomical restoration of the cervical muscles, floor of mouth and tongue were performed.
Microsurgical anastomosis of the right chin and left lingual nerve was performed.
Suture of the skin and oral mucosa was performed.
Subsequently, the patient is referred to the UVI-Patient Trauma Service where she remains 36 hours without neurological or systemic complications.
After referral to the plant, antibiotic treatment is continued for 10 days, with daily healing with antiseptic wound solution, both intraoral and cutaneous.
No infectious pathology was evidenced in that territory, presenting a favorable later evolution, being discharged on the eleventh day.
