Abstract
Since the possession of firearms is severely restricted in Japan, gunshot wounds are rarely encountered. This paper reports an experience of the management of a patient with a perforating gunshot wound. On the evening of August 20th, 1999, a 31-year old Japanese male was brought into the emergency ward of Kobe University Medical Center approximately twenty-five minutes after receiving a gunshot to the face. An entry wound was found in the left parotid lesion and there was diffuse swelling of the surrounding area. As he felt dyspnea even in a seated position, he was given a nasal intubation and brought to our department. The patient was alert and his vitalsigns were relatively stable. An X-ray examination and a computed tomography revealed a left mandibular fracture and a bullet lodged in the right submandibular triangle. An emergency operation was performed to remove the bullet and debride contaminated tissue such as the bilateral submandibular glands and hematoma. The bullet penetrated the mandible at the jaw angle. It is assumed that the bullet's path was altered, as it turned to the right and passed through the suprahyoid muscles. It is also assumed that the bullet lost most of its energy along its penetration, which would explain the relatively little damage inflicted on the surrounding tissues, such as large vessels and some cranial nerves. The patient was discharged eight days later without any deformity following uneventful post-operative course.
