This paper is to present a technique of removing a smoll air gun bullet in the brain by nasal approach. A small lead bullet was accidentally shot in the brain of a 13 years old boy through right frontal sinus. Repeated radiographic examinations including tomography were made in order to locate the accurate localization of the foreign body. The bullet was located 2 cm. above the base of the skull 5 cm. apart from the posterior bony wall of the frontal sinus and 1 cm. away to the left from the midline. A lateral rhinotomy 2as mas performed, the right ethomoid cells were excenterated, then the dura mater was incised at the roof of the cells after the bony wall was removed in an area of 2 × 3cm. The brain was carefully sounded and the bullet was locedat and removed by forceps. The postoperative course has been uneventful without any signs of intracranial complications or sequere.
The authors presented a case of operative injury of the internal carotid artery due to sinus surgery on a 13 years old malc, which followed by frequent postoperative hemorrhage. After repeated nasal packs done in attempts of controlling the hemorrhage had failed ligature of the common carotid artery was made and only this found successful. Fourteen days later however, a spontaneous rupture of the artery occured with mass hemorrhage at the ligated site and necessitated the second ligature of the artery. The authors also discussed the anatomy of the posterior most of the paranasal sinuses in relation to the location of the internal carotid artery.
Five cases of external trauma to the larynx encouttered in our department during the last two years are reported, they are two cases of lacerations of the larynx in attempts of suiside, a case of contusion associated with subcutaneous rupture of the trachea due to a traffic accident, a case of contusion with fracture and dislocation of the laryngeal cartilage struck by a timber. When the air way proved to be impinged upon, an emergency tracheotomy is to be performed and every endeavor to preserve the laryngeal function must be made. It is pointed that a poor prognosis is frequently accompanied by cricoid injuries which are usually followed by perichondritis, necrosis of the cricoicl cartilage and stenosis of the larynx (malformation of granulation tissue). In case injury involves the cricoid area, a lower tracheotmy is necessary and the affected cricoid area must be repaired at the earliest possible time.