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Gunshot Injury - Rare Presentation

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Presented in Victoria Hospital, Seychelles in 2004

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Gunshot Injury - Rare Presentation

  1. 1. Gunshot injury A rare presentation <ul><li>Dr Sanjoy Sanyal </li></ul><ul><li>Consultant Surgeon, </li></ul><ul><li>Victoria Hospital, Ministry of Health, Seychelles </li></ul><ul><li>2004 </li></ul>
  2. 2. Table of contents <ul><li>Case presentation </li></ul><ul><li>Treatment </li></ul><ul><li>Further management </li></ul><ul><li>Image findings </li></ul><ul><li>Discussion </li></ul>
  3. 3. Case presentation - history <ul><li>32-year old male </li></ul><ul><li>Security inspector in private company </li></ul><ul><li>Blast from a gun </li></ul><ul><li>C/o bleeding from (R) ear </li></ul><ul><li>C/o bleeding from mouth </li></ul><ul><li>C/o headache </li></ul>
  4. 4. Case presentation - examination <ul><li>Vitals stable </li></ul><ul><li>GCS = 15/15 </li></ul><ul><li>LMN Facial nerve palsy (R) side </li></ul><ul><li>Otoscopic examination </li></ul><ul><ul><li>AC filled with blood </li></ul></ul><ul><ul><li>Dribbling out of EAM </li></ul></ul><ul><ul><li>TM not visualised </li></ul></ul><ul><li>Intra-oral examination </li></ul><ul><ul><li>Hole in soft palate, oozing blood </li></ul></ul>
  5. 5. Postulated mechanism of injury <ul><li>Barotrauma </li></ul>
  6. 6. Case presentation - investigations <ul><li>X-ray skull </li></ul><ul><li>X-ray cervical spine </li></ul><ul><li>CT scan skull </li></ul>
  7. 7. Treatment <ul><li>Antibiotics </li></ul><ul><li>Analgesics / anti-inflammatory </li></ul><ul><li>Steroids </li></ul><ul><li>Eye care </li></ul><ul><li>Mouth care </li></ul><ul><li>Thiamine </li></ul><ul><li>Supportive measures </li></ul>
  8. 8. Further management <ul><li>Maxillo-facial </li></ul><ul><li>Physiotherapy </li></ul><ul><li>Psychiatric evaluation </li></ul><ul><li>Surgery </li></ul><ul><li>Follow up </li></ul>
  9. 9. Image findings
  10. 10. Image findings
  11. 11. Image findings
  12. 12. Image findings
  13. 13. Image findings
  14. 14. Image findings
  15. 15. Image findings
  16. 16. Discussion <ul><li>Possible mode of injury </li></ul><ul><li>Pathological anatomy </li></ul><ul><ul><li>Para-pharyngeal space </li></ul></ul><ul><li>Prognosis </li></ul><ul><ul><li>Facial nerve </li></ul></ul><ul><ul><li>Tinnitus </li></ul></ul><ul><ul><li>Other </li></ul></ul>
  17. 17. Uniqueness of case It was NOT like this
  18. 18. Thank you

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