case_images: PMC3917526_01
case_images: Photograph showing an atypical bullet entry wound. Appearance of the wound 10 days after injury. There is evidence of suppuration and areas of granulation tissue formation.
case_images: 1752-1947-8-29-1.jpg
case_images: PMC3917526_01_1752-1947-8-29-1.jpg
case_images: F1
case_images: There was a laceration of her maxillomandibular area (6cm in length) with features of infected granulation tissue (Figure 1).
case_images: Anteroposterior radiograph of the head and neck. This shows a bullet in the right side of the neck. Comminuted fracture of the mandible (angle and ramus) and maxillary antrum are revealed.
case_images: 1752-1947-8-29-2.jpg
case_images: PMC3917526_01_1752-1947-8-29-2.jpg
case_images: F2
case_images: A plain radiograph of her head and neck (Figures 2 and 3) and an ultrasound scan of her neck, done prior to her referral, had revealed the presence of a bullet in the right side of her neck, anterior to cervical vertebrae 6 and 7.
case_images: Lateral radiograph of the head and neck. This shows a bullet lodged in the neck, anterior to the bodies of cervical vertebrae 6 and 7.
case_images: 1752-1947-8-29-3.jpg
case_images: PMC3917526_01_1752-1947-8-29-3.jpg
case_images: F3
case_images: A plain radiograph of her head and neck (Figures 2 and 3) and an ultrasound scan of her neck, done prior to her referral, had revealed the presence of a bullet in the right side of her neck, anterior to cervical vertebrae 6 and 7.
case_images: Computed tomography scan of the head and neck. The scan shows a cephalad shift of the bullet to lie partially anterior to the fifth cervical vertebra. There is also a comminuted fracture of the angle and ramus of the right mandible. The section is through the median sagittal plane.
case_images: 1752-1947-8-29-4.jpg
case_images: PMC3917526_01_1752-1947-8-29-4.jpg
case_images: F4
case_images: This confirmed the earlier radiological findings; a bullet not only lodged in the right side of her neck but within her carotid sheath as well (Figure 4).
case_images: Photograph of bullet extraction. The right carotid sheath is opened exposing the retained bullet (blue arrow). Artery forceps grasp the open carotid sheath (yellow arrow). An intact area of the carotid sheath covering the caudal end of the bullet (green arrow).
case_images: 1752-1947-8-29-5.jpg
case_images: PMC3917526_01_1752-1947-8-29-5.jpg
case_images: F5
case_images: The bullet was identified, confined within a pocket of debris (Figure 5).
case_images: Photograph following bullet extraction. The bullet had lodged in the carotid sheath with damage neither to the common carotid artery (yellow arrow) nor to the internal jugular vein. There is no suppuration.
case_images: 1752-1947-8-29-6.jpg
case_images: PMC3917526_01_1752-1947-8-29-6.jpg
case_images: F6
case_images: The bullet was extracted, debris was flushed out thoroughly with normal saline (50mL) and her sheath was closed with Vicryl 2-0 continuous suture (Figure 6).