Unusual facial perforation by less lethal munition: Case report
Keywords:Orbit; Head Injuries; Rubber bullet.
Rubber bullets are considered “non-lethal weapons”, however, when they reach the facial region they can leave serious sequelae or even cause death. Such projectiles can reach the facial region, causing bone destruction, neurological and vascular damage, as well as, favoring the development of diseases. The present study aims to report a case of a 32-year-old male patient affected by a rubber bullet-compatible projectile at the time of a police dispersion. The patient attended the emergency service of the Instituto Doutor José Frota - CE, reinforced eyelid ptosis, ecchymosis and periorbital edema of both eyes, being evidenced in the left eye and a cut-contusion wound in the medial corner of the orbit. In the preoperative computed tomography, it was observed: foreign body housed in the blood base - inside the sphenoid sinus. The diagnosis and treatment decision was made by a multidisciplinary team. The patient was submitted to a surgical center under general anesthesia to remove the projectile and use LPR-F. The patient progresses with 03 (three) months of postoperative follow-up, with no signs of infection or outflow of CSF fistula. A search was performed in the literature for articles published in the years between 1975-2017 in English. The penetrating losses caused by a rubber bullet in the face must be treated by a multidisciplinary team in association with complementary exams such as a computed tomography to diagnose and define the treatment with a better prognosis.
Al-Ahmady, H. H., El Sayed, M., Fereir, A., Ekram, A., & Mousa, K. (2018). Removal of large impacted foreign body from the base of the skull through submandibular access: A multidisciplinary approach. International journal of surgery case reports, 50, 21–24. https://doi.org/10.1016/j.ijscr.2018.07.012
Amaral, M. B. F. et al (2017). Facial fractures caused by less-lethal rubber bullet weapons: case series report and literature review. Oral and Maxillofacial Surgery, 21(3), 357–361.
Ballantyne B. (2006). Medical management of the traumatic consequences of civil unrest incidents: causation, clinical approaches, needs and advanced planning criteria. Toxicological reviews, 25(3), 155–197. https://doi.org/10.2165/00139709-200625030-00003
Bloom, W. R., & Bloom, T. D. (2020). Epidemiology of Eye Injuries Caused by Personal Protection Devices and Kinetic Impact Projectile Weapons. JAMA ophthalmology, 138(12), 1318–1319. https://doi.org/10.1001/jamaophthalmol.2020.4434
Gaboriau, H. P., & Kreutziger, K. L. (1998). Penetrating injuries of the face. The Journal of the Louisiana State Medical Society: official organ of the Louisiana State Medical Society, 150(1), 6–9.
Glapa, M., Kourie, J. F., Doll, D., & Degiannis, E. (2007). Early management of gunshot injuries to the face in civilian practice. World journal of surgery, 31(11), 2104–2110. https://doi.org/10.1007/s00268-007-9220-2
Gross, M. et al. (2005). Penetrating rubber bullet into the ethmoid sinus: Should the bullet be removed? Otolaryngology - Head and Neck Surgery. 133(5), 814–6.
Kalantar Motamedi MH. Comprehensive Management of Maxillofacial Projectile Injuries at the First Operation; "Picking up the Pieces". Trauma Mon. 2013 Winter; 17(4):365-610.5812/traumamon.9279..
Karla, C. et al. (2020) Matriz autóloga de fibrina rica em plaquetas em ambientes de tratamento de feridas : uma revisão sistemática de ensaios clínicos randomizados. 11(2),.
Khonsari, R. H. et al (2010). Severe facial rubber bullet injuries: Less lethal but extremely harmful weapons. Injury, 41(1), 73–76
Kobayashi, M. & Mellen, P. F. (2009). Rubber bullet injury: Case report with autopsy observation and literature review. American Journal of Forensic Medicine and Pathology, 30(3), 262–7.
Lartizien, R. et al. (2019) Yellow vests protests: facial injuries from rubber bullets. The Lancet, 394(10197), 469–470.
Lavy, T.; Abu Asleh, S. (2003). Ocular rubber bullet injuries. Eye, 17(7), 821–824,.
McLean, J. N., Moore, C. E., & Yellin, S. A. (2005). Gunshot wounds to the face--acute management. Facial plastic surgery: FPS, 21(3), 191–198. https://doi.org/10.1055/s-2005-922859
Melo, M. N., Pantoja, L. N., de Vasconcellos, S. J., Sarmento, V. A., & Queiroz, C. S. (2017). Traumatic Foreign Body into the Face: Case Report and Literature Review. Case reports in dentistry, 2017, 3487386. https://doi.org/10.1155/2017/3487386
Millar, R. et al. (1975). Injuries caused by rubber bullets: A report on 90 patients. British Journal of Surgery, 62(6), 480–486.
Motamedi M. H. (2007). Primary treatment of penetrating injuries to the face. Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons, 65(6), 1215–1218. https://doi.org/10.1016/j.joms.2007.03.001
Pereira A. S. et al. (2018). Metodologia da pesquisa científica. UFSM. 5.3) Koche, J. C. (2011). Fundamentos de metodologia científica. Petrópolis: Vozes. Disponível em: http://www.brunovivas.com/wp content/uploads/sites/10/2018/07/K%C3%B6che-Jos%C3%A9-Carlos0D0AFundamentos-de-metodologia-cient%C3%ADfica-_-teoria-da0D0Aci%C3%AAncia-e-inicia%C3%A7%C3%A3o-%C3%A0pesquisa.pdf https://repositorio.ufsm.br /bitstream/handle/1 /15824/Lic_Computacao_Metodologia-Pesquisa-Cientifica.pdf?sequence=1
Rodríguez, Á., Peña, S., Cavieres, I., Vergara, M. J., Pérez, M., Campos, M., Peredo, D., Jorquera, P., Palma, R., Cortés, D., López, M., & Morales, S. (2020). Ocular trauma by kinetic impact projectiles during civil unrest in Chile. Eye (London, England), 1–7. Advance online publication. https://doi.org/10.1038/s41433-020-01146-w
Ueeck B. A. (2007). Penetrating injuries to the face: delayed versus primary treatment--considerations for delayed treatment. Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons, 65(6), 1209–1214. https://doi.org/10.1016/j.joms.2006.10.078
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Copyright (c) 2021 José Maria Menezes Sampaio Junior; Ricardo Franklin Gondim; Manoel de Jesus Rodrigues Mello; Rafael Linard Avelar; Jayara Ferreira de Aguiar; Josfran da Silva Ferreira Filho; Guilherme Sabóia Silveira; João Antônio Pinheiro Marques
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