Gunshot injury Gunshot injury A rare presentationA rare presentation

Dr Sanjoy SanyalDr Sanjoy Sanyal

Consultant Surgeon, Consultant Surgeon,

Victoria Hospital, Ministry of Health, SeychellesVictoria Hospital, Ministry of Health, Seychelles

20042004

Table of contentsTable of contents

Case presentationCase presentation

TreatmentTreatment

Further managementFurther management

Image findingsImage findings

DiscussionDiscussion

Case presentation - historyCase presentation - history

32-year old male32-year old male

Security inspector in private companySecurity inspector in private company

Blast from a gunBlast from a gun

C/o bleeding from (R) earC/o bleeding from (R) ear

C/o bleeding from mouthC/o bleeding from mouth

C/o headacheC/o headache

Case presentation - Case presentation - examinationexamination

Vitals stableVitals stable

GCS = 15/15GCS = 15/15

LMN Facial nerve palsy (R) sideLMN Facial nerve palsy (R) side

Otoscopic examinationOtoscopic examination AC filled with bloodAC filled with blood Dribbling out of EAMDribbling out of EAM TM not visualisedTM not visualised

Intra-oral examinationIntra-oral examination Hole in soft palate, oozing bloodHole in soft palate, oozing blood

Postulated mechanism of injuryPostulated mechanism of injury

BarotraumaBarotrauma

Case presentation - investigationsCase presentation - investigations

X-ray skullX-ray skull

X-ray cervical spineX-ray cervical spine

CT scan skullCT scan skull

TreatmentTreatment

AntibioticsAntibiotics

Analgesics / anti-Analgesics / anti-inflammatoryinflammatory

SteroidsSteroids

Eye careEye care

Mouth careMouth care

ThiamineThiamine

Supportive measuresSupportive measures

Further managementFurther management

Maxillo-facialMaxillo-facial

PhysiotherapyPhysiotherapy

Psychiatric evaluationPsychiatric evaluation

SurgerySurgery

Follow upFollow up

Image findingsImage findings

Image findingsImage findings

Image findingsImage findings

Image findingsImage findings

Image findingsImage findings

Image findingsImage findings

Image findingsImage findings

DiscussionDiscussion

Possible mode of injuryPossible mode of injury

Pathological anatomyPathological anatomy Para-pharyngeal spacePara-pharyngeal space

PrognosisPrognosis Facial nerveFacial nerve TinnitusTinnitus OtherOther

Uniqueness of caseUniqueness of case

It was NOT like this

Thank youThank you