Bilateral complete blindness following globe‑sparing single‑bullet orbital injury.

Traumatic optic neuropathy due to missile injury typically results in unilateral visual loss.[1] We discuss an uncommon case, in which injury from retroocular passage of a single bullet resulted in bilateral orbital perforations, frozen globes, and complete blindness. A 20‑year‑old female presented with bilateral absent light perception detected immediately, following alleged accidental bullet injury. There were no cranial manifestations and sutured skin wounds were visible on the temporal aspects of both the orbits. Bilateral ocular coats were intact with normal intraocular pressure and anterior segments. However, there was bilateral complete afferent pupillary defect and vitreous hemorrhage. Noncontrast computerized tomography (NCCT) imaging revealed multiple orbital and nasal fractures, a bony fragment abutting the right globe [Fig. 1a], and bilateral temporal orbital perforations on reconstructed images [Fig. 1b and c]. The entry wound was left‑sided and slightly lower than the right‑sided exit wound [Fig. 1b and c]. Sonography revealed attached bilateral retinas. The combination of complete afferent and efferent neural dysfunction was attributed to injury of bilateral posterior orbits near the apical region. No ocular intervention was planned due to poor prognoses and absence of any foreign body.

Surgical correction of severe enophthalmos caused by bullet injury.

Ballistic injuries of oral and maxillofacial region are usually fatal due to close propinquity with the vital structures. The severity of injury depends on the caliber of the weapon used and distance from which the patient is shot. The preliminary care of facial ballistic wounds strictly adheres to the basics of trauma resuscitation. Early and appropriate surgical management has proved to be influential on the final outcome and esthetic result. Treatment of facial gunshot wounds should be planned and carried out carefully to avoid esthetic complications. It takes even multiple‑staged corrections to achieve the targeted functional and esthetic treatment plan. Prevention and control of infection is one of the most important goals to achieve the success of the treatment. Herewith, we present a case of facial gunshot injury with fractures in the orbital floor, medial wall maxillary sinus, and buttress of the zygomatic bone causing deficit, which was successfully managed by surgical reconstruction.

Radiculopathy as Delayed Presentations of Retained Spinal Bullet

Bullet injuries to the spine may cause injury to the anatomical structures with or without neurologic deterioration. Most bullet injuries are acute, resulting from direct injury. However, in rare cases, delayed injury may occur, resulting in claudication. We report a case of intradural bullet at the L3-4 level with radiculopathy in a 30-year-old male. After surgical removal, radicular and claudicating pain were improved significantly, and motor power of the right leg also improved. We report the case of intradural bullet, which resulted in delayed radiculopathy.

Concept of Gunshot Wound Spine

Gunshot wound (GSW) to the spine which was earlier common in the military population is now being increasingly noted in civilians due to easy availability of firearms of low velocity either licensed or illegal combined with an increased rate of violence in the society. Contributing to 13% to 17% of all spinal injuries, the management of complex injury to the spine produced by a GSW remains controversial. Surgery for spinal cord injuries resulting from low velocity GSWs is reserved for patients with progressive neurologic deterioration, persistent cerebrospinal fluid fistulae, and sometimes for incomplete spinal cord injuries. Surgery may also be indicated to relieve active neural compression from a bullet, bone, intervertebral disk, or a hematoma within the spinal canal. Spinal instability rarely results from a civilian GSW. Cauda equina injuries from low velocity GSWs have a better overall outcome after surgery. In general, the decision to perform surgery should be made on consideration of multiple patient factors that can vary over a period of time. Although there have been plenty of individual case reports regarding GSW to the spine, a thorough review of unique mechanical and biological factors that affect the final outcome has been lacking. We review the key concepts of pathogenesis and management of GSW to the spine and propose an algorithm to guide decision making in such cases.

Early Pulmonary Pathology after Bullet Injury on Hind Legswith Bone Fracture in Dogs / 第三军医大学学报

The pathological changes of the lungs in 16 dogs with blulet-caused fracture of the hind legs were studied. Under light microscopy, the pathological features were marked capillary congestion, extravasation of red cells in either the interstitium or alveolar spaces, atelectasis, leucocyte infiltration of the interstitium, mild pulmonary edema, and fat emboli in the small vessels. These changes, with the exception of fat embolism, were found to occur 2 hours after injury, and were fully developed around 24 hours. Then fat embolism supervened. Most of the changes gradually subsided and disappeared as time went by.The results of this study indicate that there can be pathological lesions in the lungs secondary to the bullet-induced fracture of the hind legs in dogs.