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Mandible prognathism saved a life: a case report
Chinese Journal of Traumatology 2010; 13(5):319-320
. 319 .
Case report
Mandible prognathism saved a life: a case report Hamid Mahmood Hashemi* and Asadollah Asgarian
【Abstract】An unusual case of a suicidal firearm injury is presented, in which the victim placed the gun under his chin and fired. However, none of the vital structures of the head and face were injured because the victim's chin was considerably anterior to other facial structures as a result of a class III facial deformity. This resulted in the
T
he head and face are the most common targets for homicidal and suicidal firearm attacks. This is primarily because of the fact that, due to the presence of such a vital structure as the brain within this specific area, firearm attacks to the head and face are associated with a significantly higher mortality rate compared to attacks to other areas of the body. We reported an unusual case of a suicidal firearm injury sustained a bullet traversing from the mandible all the way up to the face without causing death or severe morbidity to the victim.
trajectory of the bullet being anterior to vital facial structures and not causing injury to those structures. Key words: Wounds, gunshot; Mandible; Prognathism; Suicide Chin J Traumatol 2010; 13(5):319-320
Clinical examination revealed a large entry wound approximately 1.5 cm×2 cm under the chin and a slightly larger exit wound on the inferior part of the forehead near the glabella. The anterior part of the mandible and maxilla together with the associated teeth, the lower and upper lips, the nasal septum and bones as well as the overlying soft tissues were involved. The eyes and other facial structures located on both sides of the midline were intact. From a medical point of view, he was in a stable state without any significant signs and symptoms of neurological or cardiopulmonary problems.
CASE REPORT A 19-year-old man walked into the emergency ward of our hospital with significant soft and hard tissue injuries on the face, allegedly owing to a firearm suicidal attack sustained 1 hour previously. According to the patient, he had placed the tip of the gun under his chin and fired a bullet in order to kill himself. He had lost his consciousness for a few minutes, then was transferred to another hospital for receiving primary medical care, and finally walked to our hospital for advanced care.
DOI: 10.3760/cma.j.issn.1008-1275.2010.05.014 Department of Oral & Maxillofacial Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran 15614, Iran (Mahmood Hashemi H and Asgarian A) *Corresponding author: Tel: 98-2188220000, Fax: 982188633039, E-mail: [email protected]
Both clinical and radiographic examinations confirmed that the frontal sinuses and the more posterior parts of the nasal structure were intact (Figure 1). Furthermore, the injury of the maxilla was dentoalveolar in nature, without significant damage to the body of the maxillary bone. However, the bullet caused not only a dentoalveolar fracture at the anterior part of the mandibular arch, but also a symphyseal fracture without significant bone loss. The patient was taken into the operating room immediately and under general anesthesia, the soft and hard tissue injuries were repaired. The postoperative period was uneventful, and the patient was satisfied with the outcomes of the surgical intervention (Figures 2 and 3).
Chinese Journal of Traumatology 2010; 13(5):319-320
. 320 .
Figure 1. Lateral cephalometric view of the victim's face showing marked mandibular prognathism. Figure 2. Postoperative view of the entrance site of the bullet. Figure 3. Dentoalveolar injury to the anterior maxilla and mandible as a result of the bullet.
DISCUSSION Self-inflicted gunshot wounds are relatively common, especially in the industrialized world. During the year 2003 in the United States, 16 820 individuals died from firearm suicidal attacks, and more than double of this number of people shot themselves and survived but with permanent disabilities.1 The most common risk factors for self-inflicted gunshot injuries include drug abuse, psychiatric disorders, and poor socioeconomical status. The last one is apparently the main cause of committing suicide for our patient. A thorough psychiatric evaluation of him revealed no significant disorders.
variety of ballistic factors, including velocity, mass, and deformation of the bullet.2 It also depends on the head and face anatomy of the victim, a point if neglected, sometimes could save a life! In the case presented here, the patient placed the gun under his chin and fired. Since his chin was considerably anterior to the vital head and face structures such as the orbit and the cranial base, the trajectory of the bullet was anterior to these vital structures and did not damage them.
REFERENCES 1. Melugin MB. Maxillofacial firearm injuries. In: Fonseca RJ, ed. Oral and maxillofacial trauma. Volume 2. Missouri: Saunders, 2005:931-948. 2. Maisel RH, Hom DB. Blunt and penetrating trauma to the
The extent of soft and hard tissue damage following a gunshot injury to the head and face depends not only on where the tip of the gun is placed, but also on a
neck. In: Cummings CW, ed. Otolaryngology, head and neck surgery. Volume 3. Pennsylvania: Mosby, 2005:2525-2539. (Received June 7, 2010) Edited by LIU Gui-e
. 319 .
Case report
Mandible prognathism saved a life: a case report Hamid Mahmood Hashemi* and Asadollah Asgarian
【Abstract】An unusual case of a suicidal firearm injury is presented, in which the victim placed the gun under his chin and fired. However, none of the vital structures of the head and face were injured because the victim's chin was considerably anterior to other facial structures as a result of a class III facial deformity. This resulted in the
T
he head and face are the most common targets for homicidal and suicidal firearm attacks. This is primarily because of the fact that, due to the presence of such a vital structure as the brain within this specific area, firearm attacks to the head and face are associated with a significantly higher mortality rate compared to attacks to other areas of the body. We reported an unusual case of a suicidal firearm injury sustained a bullet traversing from the mandible all the way up to the face without causing death or severe morbidity to the victim.
trajectory of the bullet being anterior to vital facial structures and not causing injury to those structures. Key words: Wounds, gunshot; Mandible; Prognathism; Suicide Chin J Traumatol 2010; 13(5):319-320
Clinical examination revealed a large entry wound approximately 1.5 cm×2 cm under the chin and a slightly larger exit wound on the inferior part of the forehead near the glabella. The anterior part of the mandible and maxilla together with the associated teeth, the lower and upper lips, the nasal septum and bones as well as the overlying soft tissues were involved. The eyes and other facial structures located on both sides of the midline were intact. From a medical point of view, he was in a stable state without any significant signs and symptoms of neurological or cardiopulmonary problems.
CASE REPORT A 19-year-old man walked into the emergency ward of our hospital with significant soft and hard tissue injuries on the face, allegedly owing to a firearm suicidal attack sustained 1 hour previously. According to the patient, he had placed the tip of the gun under his chin and fired a bullet in order to kill himself. He had lost his consciousness for a few minutes, then was transferred to another hospital for receiving primary medical care, and finally walked to our hospital for advanced care.
DOI: 10.3760/cma.j.issn.1008-1275.2010.05.014 Department of Oral & Maxillofacial Surgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran 15614, Iran (Mahmood Hashemi H and Asgarian A) *Corresponding author: Tel: 98-2188220000, Fax: 982188633039, E-mail: [email protected]
Both clinical and radiographic examinations confirmed that the frontal sinuses and the more posterior parts of the nasal structure were intact (Figure 1). Furthermore, the injury of the maxilla was dentoalveolar in nature, without significant damage to the body of the maxillary bone. However, the bullet caused not only a dentoalveolar fracture at the anterior part of the mandibular arch, but also a symphyseal fracture without significant bone loss. The patient was taken into the operating room immediately and under general anesthesia, the soft and hard tissue injuries were repaired. The postoperative period was uneventful, and the patient was satisfied with the outcomes of the surgical intervention (Figures 2 and 3).
Chinese Journal of Traumatology 2010; 13(5):319-320
. 320 .
Figure 1. Lateral cephalometric view of the victim's face showing marked mandibular prognathism. Figure 2. Postoperative view of the entrance site of the bullet. Figure 3. Dentoalveolar injury to the anterior maxilla and mandible as a result of the bullet.
DISCUSSION Self-inflicted gunshot wounds are relatively common, especially in the industrialized world. During the year 2003 in the United States, 16 820 individuals died from firearm suicidal attacks, and more than double of this number of people shot themselves and survived but with permanent disabilities.1 The most common risk factors for self-inflicted gunshot injuries include drug abuse, psychiatric disorders, and poor socioeconomical status. The last one is apparently the main cause of committing suicide for our patient. A thorough psychiatric evaluation of him revealed no significant disorders.
variety of ballistic factors, including velocity, mass, and deformation of the bullet.2 It also depends on the head and face anatomy of the victim, a point if neglected, sometimes could save a life! In the case presented here, the patient placed the gun under his chin and fired. Since his chin was considerably anterior to the vital head and face structures such as the orbit and the cranial base, the trajectory of the bullet was anterior to these vital structures and did not damage them.
REFERENCES 1. Melugin MB. Maxillofacial firearm injuries. In: Fonseca RJ, ed. Oral and maxillofacial trauma. Volume 2. Missouri: Saunders, 2005:931-948. 2. Maisel RH, Hom DB. Blunt and penetrating trauma to the
The extent of soft and hard tissue damage following a gunshot injury to the head and face depends not only on where the tip of the gun is placed, but also on a
neck. In: Cummings CW, ed. Otolaryngology, head and neck surgery. Volume 3. Pennsylvania: Mosby, 2005:2525-2539. (Received June 7, 2010) Edited by LIU Gui-e