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Missile localization in a gunshot wound victim
380
Radiology forum
ORAL SURG ORAL.
probably due to incomplete removal of the fixer solution, it may cause the affected portion of the image to further deteriorate, by fading and discoloring with time. Perhaps the best solutions to the problem described in this brief report are in the hands of the manufacturers of the intraoral x-ray film or the processors. One solution is a modification in the thickness of the indicating dot; the other is an adjustment in proces-
MISSILE VICTIM
LOCALIZATION
IN A GUNSHOT
MED ORAL PATHW September 199 I
sors to factor in the presence of the raised portion of the film. Jose F. Padilla Neil1 J. Serman School of Dental and Oral Surgery Columbia University 630 W. 168th St. New York, NY 10032
WOUND
A
19-year-old man was seen at the Johns Hopkins Hospital emergency room after sustaining a gunshot wound. A .38-caliber missile had entered the left side of the patient’s back and deflected off the scapula, passed through the neck, impacted with the right mandibular lingual cortex, and came to rest in the patient’s oral tissues. The patient did not lose consciousness or have airway obstruction. Neurologic examination was within normal limits, and angiography confirmed that there was no injury to the major blood vessels in the neck. Dental examination revealed a stable, repeatable occlusion. No mucosal lacerations, ecchymoses, or swellings were present. A small step-off defect was found on palpation of the right mandibular inferior cortex. The patient did not have paresthesia or trismus, only moderate discomfort in the entrance wound area. Pantomography (Fig. 1) revealed fracture of the right mandibular inferior cortex, and the missile appeared to be lodged in the body of the mandible, inferior to the root apexes of the mandibular right first molar tooth. Occlusal radiography (Fig. 2), however, showed the missile to be positioned in the soft tissues of the right side of the mouth. The patient was discharged from the hospital after copious irrigation of the entry wound and administration of antibiotics and analgesics. Radiographs taken during follow-up care have shown no movement of the missile foreign body. Surgical intervention is not anticipated unless the missile becomes symptomatic or shows signs of migration. This case is a reminder of the importance of taking two radiographs at right angles to each other for proper localization. Scott B. Wolpin, DMD Eastern Shore, Aid.
1. Panoramic radiographshowingforeign body on right sideof mandible. Fig.
2. Occlusalview showedforeignbody to belocalized in floor of mouth. Fig.
Radiology forum
ORAL SURG ORAL.
probably due to incomplete removal of the fixer solution, it may cause the affected portion of the image to further deteriorate, by fading and discoloring with time. Perhaps the best solutions to the problem described in this brief report are in the hands of the manufacturers of the intraoral x-ray film or the processors. One solution is a modification in the thickness of the indicating dot; the other is an adjustment in proces-
MISSILE VICTIM
LOCALIZATION
IN A GUNSHOT
MED ORAL PATHW September 199 I
sors to factor in the presence of the raised portion of the film. Jose F. Padilla Neil1 J. Serman School of Dental and Oral Surgery Columbia University 630 W. 168th St. New York, NY 10032
WOUND
A
19-year-old man was seen at the Johns Hopkins Hospital emergency room after sustaining a gunshot wound. A .38-caliber missile had entered the left side of the patient’s back and deflected off the scapula, passed through the neck, impacted with the right mandibular lingual cortex, and came to rest in the patient’s oral tissues. The patient did not lose consciousness or have airway obstruction. Neurologic examination was within normal limits, and angiography confirmed that there was no injury to the major blood vessels in the neck. Dental examination revealed a stable, repeatable occlusion. No mucosal lacerations, ecchymoses, or swellings were present. A small step-off defect was found on palpation of the right mandibular inferior cortex. The patient did not have paresthesia or trismus, only moderate discomfort in the entrance wound area. Pantomography (Fig. 1) revealed fracture of the right mandibular inferior cortex, and the missile appeared to be lodged in the body of the mandible, inferior to the root apexes of the mandibular right first molar tooth. Occlusal radiography (Fig. 2), however, showed the missile to be positioned in the soft tissues of the right side of the mouth. The patient was discharged from the hospital after copious irrigation of the entry wound and administration of antibiotics and analgesics. Radiographs taken during follow-up care have shown no movement of the missile foreign body. Surgical intervention is not anticipated unless the missile becomes symptomatic or shows signs of migration. This case is a reminder of the importance of taking two radiographs at right angles to each other for proper localization. Scott B. Wolpin, DMD Eastern Shore, Aid.
1. Panoramic radiographshowingforeign body on right sideof mandible. Fig.
2. Occlusalview showedforeignbody to belocalized in floor of mouth. Fig.