Retained Bullet Fragments in the Head and Neck

Retained bullet fragments in the head and neck Authors: Ryan M. D. Calvi M.S. D.M.D., Richard J. Hammond D.M.D., John S. Vorrasi D.D.S. Affiliation: Christiana Care Health System, Newark Delaware Retained fragments from projectiles are a common consequence of gunshot wounds in the head and neck region. We retrospectively reviewed the records at our institution over the past 4 years on patients with gunshot wounds to the head and neck with retained projectile fragments. We found 20 patients with retained projectiles in the head and neck region, ranging from 1 – 19 retained projectiles. We looked at the rate of infection, need for removal, migration and the need for antibiotics. During the initial acute phase 30% of the patients had their projectiles initially removed at the time of initial washout and wound debridement. In the postoperative period additional projectiles required removal; 10% due to patients wishes for removal, 5% were removed due to reduced function, and 10% were removed due to infection. No evidence of migration was noted in subsequent follow-up radiographs and clinical exam. With all patients given antibiotics during the initial presentation, only a small subset of patients developed an infection in the postoperative period. There is no evidence supporting antibiotic use to prevent infections. There is a low risk of infection and migration even considering oral pharyngeal contamination. Hollier L, Grantcharova E, Kattash M: Facial Gunshot Wounds: A 4-Year Experience: J Oral Maxillofac Surg 59:277-282, 2001 Dolin J, Scalea T, Mannor L, Sclafani S, Trooskin S: The management of gunshot wounds to the face. J Trauma 33:508-515, 1992 Motamedi MHK: Primary management of maxillofacial hard and soft tissue gunshot and shrapnel injuries: J Oral Maxillofac Surg 61:1390-1398, 2003