Telescopic removal of bullet in a challenging case of gunshot injury

Introduction: The incidence of gunshot but is wounds on the face has been on a rise still rare as compared to firearm injuries to other regions of the body. Such injuries can be devastating due to the presence of vital structures in the vicinity. We describe a rare case of retained bullet in the infratemporal fossa which presented with delayed onset facial nerve palsy and was meticulously removed with the help of 0 degree endoscope. Case report: A 36 year old male reported to the emergency department for management of a homicidal gunshot injury to left side of face. The patient developed left sided facial nerve palsy6 days following the episode. Computerised tomography of the face revealed presence of metallic foreign body impacted in the infratemporal fossa with associated mandibular condyle and temporal bone fracture. The bullet was located in a critical position only within 5mm of carotid artery. The entry wound was explored and Hopkins O degree endoscope was used to further trace the entry wound down up to the infratemporal fossa. Conclusion: The successful outcome depends on careful planning and multidisciplinary team approach. In our case, we would also like to highlight that the use of endoscope was extremely helpful and helped us to avoid the morbidity associated with external approach. Correspondence to: Dr. Nilam U. Sathe, Associate Professor, Department of ENT and Head – Neck Surgery, Seth G. S. Medical College and KEM Hospital, Parel, Mumbai, India; TeL: +91 9821309298; E-mail: [email protected]