Removal of a bullet from an infratemporal space one year after original injury

Removal of a bullet from an infratemporal space one year after original injury Report

of a case

Harold E’irfer, D.D.r\*.,* and David II. Sohn, D.D.Is.,* Uvicago, Ill. COOK

COUNTY

HOSPITAI,

M

any patients with trismus come to the oral surgeon for initial treatment. The most frequent cause of trismus is probably dental infection, and peritonsillar infection is probably the second most common. Other causes may include brain tumors causing neurologic lesions, local tumors in the region of the temporomandibular joint, arthritic processes, and so on. Trismus as the result of a foreign body is not very common. CASE

REPORT

On April 2, 1961, a 27.year-old Negro man was admitted to the Oral Surgery Service complaining of inability to open his mouth. He stated that about 10 days earlier, while eating he experienced difficulty in opening his mouth and that this had beeomc progressively worse. IIe could nom open his mouth no more than 3 mm. anteriorly, He related that about I year previously he had been shot in the left neck. He had been hospitalized, examined, and x-rayed, but the bullet was not removed from Tvhere it had lodged. The past medical history included an appendectomy and a ruptured left tympanic membrane not related to the bullet wound. Physical examination revealed a normal man in good health except for the ahove-noted defects. There was limitation of mandibular movement and slight tenderness high in the right fornix. There was a suggestion of a mass at the point of tendrrncss, which was assumed to bc the foreign body. Hilateral nondiscrete cervical nodes WU’P notrd. The pat,ient was afebrile. Boentgenographic examination to localize the bull& was ordered. A posteroanterior roentgenogram of the sku!l revealed the bullet to bc media,1 to the coronoid process of the mandible (Fig. 1). A true lateral projection showed the bullet to be posterior to the maxilla, near the tuberosity, above the level of the alveolar process, that is, in thr right infratemporal fossa (Fig. 2). There was no evidence of old or new injury to hone. The bullet had apparently passed from the left neck to the right infratemporal fossa without hitting hard structures. *Formerly

580

Senior

Resident

in Oral

Surgery,

Cook

County

Hospital.

Eemoval

Fig.

1. F ‘oateroanterior

Fig.

2. True

lateral

roentgenogram

view

of skull

of

Bullet

of skull

showing

bullet

from

showing

posterior

infratemporal

bullet

lateral

to tuberosity

space

to coron loid

of maxilla.

581

pro< sess.

582

Firfer

nncl

Soha

Routine chest x-ray findings were normal. l~alro~~ator~ mimtir~si ioup of I)lood and urine showed no abnormality. The patient was prepared for surgery and premetlic~atcd with at ropine, Phenergan, and Demerol. A nasotracheal tube was passed, and anesthesia was maintained with nitrous oxide, oxygen, and ether. Xylocaine, 1 per cent, with Adrenalin 1 :lOO,OOfl \vas infiltrated into the infratemporal space for hemostasis. An iucision was math in tllr rnucobuccal fold from the tuberosity to the premolar area, and the infratemporal space was explored until the bullet was located. There was considerable granulation tissue about it. A rubber drain was placed within the cavity from which the bullet was removc~l ( Fig. :I ) 1 and the wound was closed with 3-O black silk. Recovery was uneventful. In 48 hours the drain was remowd. On tile third postoperative day the patient was discharged to the outpatient clinic. He was able to open his mouth wide. He was seen 1 vveek, 4 weeks, and 6 months postoperatively. He retained complete function of the mandible. Postoperative roentgenograms revealed that the foreign I~ody had been completely removed. 6723 30

N.

W. Stanley, Michigan

Remyn,

Act.,

111.

Chicago,

(ZZ2i.F.) Ill. (l~X.8.)