Transoral Removal of Missile Fragments from the C1-C2 Area: Report of Four Cases

Abstract

Low velocity firearm damage to the upper cervical spine without neurological deficit occurs infrequently. Four cases of gunshot fragments involving the anterior elements of C1 and C2 are presented. In all four cases, the fragments were removed via a transoral approach without neurological complications or mechanical instability.

Spontaneous expulsion of a bullet, in the body of second cervical vertebrae, via the mouth

“…In a stable patient without neurological deficit, missiles retained in the anterior portion of C1-C2 may also induce both short-term and long-term complications. This condition makes the fragment removal a reasonable option [3]. Similarly, in our patient, the bullet lodged in the body of C2 started to migrate anteriorly after 40 days, and spontaneously left via mouth.…”

“…The consequences of gunshot wounds to the upper cervical spine are most often devastating, including spinal cord dysfunction and even death resulting from airway injuries [1][2][3]. Infrequently, patients with cervical spine gunshot injury sustain a fracture alone or are left with a retained vertebral missile fragment [3].…”

“…Infrequently, patients with cervical spine gunshot injury sustain a fracture alone or are left with a retained vertebral missile fragment [3]. Therefore, Fig.…”

“…Therefore, conservative methods have mostly been preferred in such cases. Most often, these patients have been followed with immobilization alone [2,3]. As there was no neurological deficit and instability on physical examination, and the bullet had no relationship with the spinal channel in radiological investigation, we preferred immobilization with a cervical collar.…”

Migration of a Bullet in the Lumbar Intervertebral Disc Space Causing Back Pain -Case Report-

“…12) Civilian physicians usually treat gunshot wounds produced by handguns with low velocities of less than 700 m/sec, and the bullets must transverse or remain inside the spinal canal to cause neurological deficits. The greater kinetic energy of high-velocity military weapons has a greater kinetic effect which can result in neurological injury even without spinal fracture, penetration, or retained missile fragments.…”