27-year-old woman presented to the emergency with a stray bullet lodged in her neck.
A 27-year-old African-Ugandan female patient presented to the emergency department of a tertiary care hospital with a bullet lodged in her neck. The patient was given CPR and surgical wound toilet were done without wound extension. The wound was dressed, antibiotics and vaccines were administered. The right side of the patient’s face was injured with a large open wound.
She was referred to a tertiary care hospital 10 days after the injury. The 27-year-old complained of pain on the right side of the mandible, difficulty opening her mouth and chewing, in addition to a hearing disability in her right ear. Further examination showed stridor, dyspnoea, subcutaneous emphysema and with no active bleeding. A 6 cm laceration was also evident in the maxillomandibular area. The ride side of the patient’s maxillofacial region was also swollen and tender.
Examination further revealed a limited mouth opening with no particularly painful area in the neck. Cranial nerve examination was remarkable of right facial nerve palsy and total loss of cutaneous sensation over the right maxillary and mandibular branches of her trigeminal nerve. Ophthalmic division of the trigeminal nerve was intact.
The patient’s radiograph and ultrasound of the head and neck revealed a bullet in the right side of her neck, anterior to cervical vertebrae 6 and 7. Radiological findings further confirmed a comminuted fracture of the ramus and angle of the mandible. 1 week after admission a CT scan was performed which confirmed the previous radiological findings. The bullet was found to be lodged not just anterior to cervical vertebrae 6 and 7, however, also anterior to the cervical vertebra. No suppuration or inflammation was present.
The bullet was surgically extracted and debris flushed out.
