Surgical treatment of projectile in the infratemporal fossa. Case report

Abstract

BACKGROUND AND OBJECTIVES:Gunshot wounds may have fatal results. Even when not causing major injuries to soft and hard tissues, there may be other severe problems. This study aimed at reporting the case of a projectile located in the left infratemporal fossa and at discussing treatment, risks and complications. CASE REPORT: Male patient, 18 years old, suffered a gunshot wound which has penetrated the face by the left zygomatic region, and was lodged in the homolateral infratemporal fossa. This has caused jaw function impairment and pain. Foreign body was surgically removed by preauricular access and patient was then submitted to physiotherapy. After treatment, temporomandibular joint function was reestablished and esthetic results were considered excellent without sequelae. CONCLUSION: Management of patients hit by projectiles is more complex when these are located in an area of difficult access and close to noble structures. Radiographic techniques obtained by means of different planes allow the accurate location of the object. There may be major deformity and functional incapacity, especially if the facial nerve is affected during bullet trauma or during surgery. Although there were no nervous injuries, functional impairment of orofacial structures was decisive to indicate the surgical procedure. Surgical removal of the projectile from the infratemporal fossa, combined with postoperative physiotherapy, has shown to be an effective treatment. Keywords: Infratemporal fossa, Projectile, Rehabilitation, Temporomandibular joint. Surgical treatment of projectile in the infratemporal fossa. Case report RESUMO JUSTIFICATIVA E OBJETIVOS:Ferimentos causados por arma de fogo podem ter resultados fatais. Mesmo que a bala não cause grandes lesões para os tecidos moles e duros, outros problemas graves podem ocorrer. O objetivo deste estudo foi relatar o caso de um projétil localizado na fossa infratemporal esquerda, discutir o tratamento cirúrgico, seus riscos e complicações. RELATO DO CASO: Paciente do gênero masculino, 18 anos, sofreu um ferimento por arma de fogo que penetrou na face pela região zigomática esquerda, alojando-se na fossa infratemporal homolateral. Esse ocasionou comprometimento da função mandibular e dor. O corpo estranho foi removido cirurgicamente por meio do acesso pré-auricular e o paciente foi posteriormente submetido a sessões de fisioterapia. Após o tratamento, foi reestabelecida a função da articulação temporomandibular, a dor desapareceu e os resultados estéticos foram considerados excelentes, sem sequelas. CONCLUSÃO: O manuseio dos pacientes acometidos por projétil torna-se mais complexo quando esse está localizado em uma área de difícil acesso e ao lado de estruturas nobres. Técnicas radiográficas, obtidas por meio de diferentes planos, permitem uma localização precisa do objeto. Grande deformidade e incapacidade funcional podem ocorrer, especialmente, se o nervo facial é afetado durante o trauma balístico ou durante o ato cirúrgico. Apesar de não haver lesões nervosas, o comprometime...

Ballistic projectiles removal in head and neck region

“…Regarding the pathophysiology and magnitude of this type of injury, factors such as caliber, composition, PAFs velocity, shot distance, penetration angle, path and direction of transferred energy, density and size of the affected tissue, should be taken into account for a better understanding of each clinical case, especially in the treatment to be instituted and in the expected prognosis [2,5,[7][8][9][10][11].…”