Penetrating Rubber Bullet into the Ethmoid Sinus: Should the Bullet be Removed?

Abstract

P enetrating rubber bullet injuries are classified as low-velocity penetrating injuries. In this report, we describe such a case and review the management of penetrating rubber bullet injuries with a retained bullet in the paranasal sinuses.

Treatment of a Penetrating Intraorbital Injury by Rubber Projectile

“…2 A CT scan should be performed to allow appropriate topographic diagnosis, and angiography can be used when vascular injuries are suspected or when the projectile reaches deeper regions and posterior to the coronal plane of the mandibular angles. 4 Most of these projectiles are lodged in the maxillary and ethmoidal sinuses, thereby promoting sinusitis, injuries to the ocular bulb, and large defects in the orbital walls. 4,6 In the case reported here, the projectile reached the intraorbital region and was lodged within the orbital cone, causing eye injury and bone defects to the floor and medial wall.…”

“…4 Most of these projectiles are lodged in the maxillary and ethmoidal sinuses, thereby promoting sinusitis, injuries to the ocular bulb, and large defects in the orbital walls. 4,6 In the case reported here, the projectile reached the intraorbital region and was lodged within the orbital cone, causing eye injury and bone defects to the floor and medial wall. Another particularity in this case was that the projectile also reached deeper planes, all the way to the sphenoid sinus, thus constituting an increased risk of vascular injury.…”

“…2,3 Ideally, when using rubber projectiles, shooting should be aimed at the lower body from a minimum distance of 40 m from the target. 4 However, shots hitting the craniofacial region and even deaths have been reported. 3,5 Although rare, facial injuries caused by rubber projectiles may be penetrating due to the low elasticity of the skin and bones of the midface.…”

“…3,5 Although rare, facial injuries caused by rubber projectiles may be penetrating due to the low elasticity of the skin and bones of the midface. 4 Additionally, due to the low speed of these projectiles, these end up being lodged in regions without exit projectile orifices. 4 Given these circumstances, the removal of the projectile and correction of orbital fractures are essential for preventing the risk of infection and minimizing later problems associated with ocular rehabilitation, such as the anophthalmic orbit syndrome, characterized by enophthalmos of the prosthesis, depression of the superior orbital sulcus, and ptosis of the lower lid.…”

“…4 Additionally, due to the low speed of these projectiles, these end up being lodged in regions without exit projectile orifices. 4 Given these circumstances, the removal of the projectile and correction of orbital fractures are essential for preventing the risk of infection and minimizing later problems associated with ocular rehabilitation, such as the anophthalmic orbit syndrome, characterized by enophthalmos of the prosthesis, depression of the superior orbital sulcus, and ptosis of the lower lid. 6 The objective of this article is to report a case involving injury to the orbital region by rubber projectile associated with a loss of vision and late treatment of a large orbital floor defect.…”