Endoscopic removal of a bullet from the parapharyngeal space just anterior-lateral to the first vertebral body: case report

Abstract

In all head and neck bullet injuries, treatment has to be individualized, as there is no universal protocol for all cases. Five important steps of management should be taken: securing airways, hemorrhage control, recognizing other injuries, foreign body removal when necessary, and repair of facial wounds. In this report, the case of a 28-year-old male patient will be presented and discussed. The patient was referred from a surgery clinic to an ear, nose and throat (ENT) outpatient clinic complaining of right neck pain, throat pain, and foreign body sensation in the throat for 2 months following a firearm injury to his face. The entry wound was observed on the left alar cartilage of his nose, which was almost healed and had left a scar. A sinus computed tomography scan showed a bullet in the right parapharyngeal space about 3 mm in front of the first vertebral body. The bullet was successfully removed using a trans-nasal endoscopic approach with the support of an image-guided navigational system and frequent fluoroscopy. These 2 methods help to replace the old traditional open approaches.

Navigation-assisted minimally invasive bullet removal in the lumbar spine: a case report

“…While retaining the foreign body may lead to late migration and even neurological compromise [2], aggressive management may cause collateral iatrogenic injury [3]. Several studies have demonstrated a minimally invasive technique to remove bullets from the cervical spine [4,5]; however, similar procedures for the lumbar spine have rarely been mentioned. Advancements in navigation-assisted surgery have expanded the indications from thoracolumbar pedicle screws to deformity correction and spine tumor resection over the years [6].…”