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Endoscopic removal of bullets from the cranial ridge junction region via transoral and transnasal approaches

View Article: PubMed Central - PubMed

ABSTRACT

Endoscopes in otolaryngology may facilitate accessing the lumens and sites such as upper cervical spine with minimally invasive surgical exposure. Here, we present 2 interesting cases of youth who underwent endoscopic removal of bullets in the cranial ridge junction region.

The first case was a 20-year-old young man who underwent a gunshot in the face. A CT scan showed that a metallic foreign body located inside the right lateral body of Atlas that presented a comminuted fracture. The second case a 36-year-old man who also underwent a gunshot in the face. CT scan showed a foreign body lodged in the soft tissues before the right anterior arch of Atlas cone (C1) that presented a fracture. The bullets in these 2 patients were removed under the endoscopes with minimal damage, respectively. The patients were discharged without neck activity obstacle.

The advantage of endoscopic technique is obvious because limited visualization does not damage surrounding tissues, thus decreasing surgical complications. This was an interesting experience of surgical operation in this region.

No MeSH data available.


The second case: (A) sagittal CT scan showed that the bullet was located at the cranial ridge junction region; (B) intraoperative image of the bullet under the endoscopy. (C) sagittal CT scan confirmed the removal of the bullet (the arrows show the location of the bullet). CT = computed tomography.
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Figure 2: The second case: (A) sagittal CT scan showed that the bullet was located at the cranial ridge junction region; (B) intraoperative image of the bullet under the endoscopy. (C) sagittal CT scan confirmed the removal of the bullet (the arrows show the location of the bullet). CT = computed tomography.

Mentions: The second case was a 36-year-old man who was admitted to our hospital on Mar 09, 2015, that had been 17 days after being shot in the face on Feb 20, 2015. The patient was awake and alert without conscious disturbance, airway and neck activity difficulties, and neurovascular compromise. The bullet had passed into the right alveolar process of the upper jaw bone and had broken the alveolar bone. CT scan showed a foreign body lodged in the soft tissues before the right anterior arch of Atlas cone (C1) that presented a fracture, without the vertebral artery and odontoid damaged. Under general anesthesia, transoral and transnasal visualization was achieved by using a 4-mm zero-degree nasal endoscope. An incision was made in the right side of the retropharyngeal wall. After careful dissection of the adjacent tissues, the bullet was fully found and taken out. Compression hemostasia was used at the operating field. The patient was then discharged without neck activity obstacle. One month later, CT scan confirmed the disappearance of the foreign body and the stability of the cervical vertebra (Fig. 2). This study was approved by the ethics committee of Southwest Hospital (Chongqing, China) and the informed consent was obtained from the patients.


Endoscopic removal of bullets from the cranial ridge junction region via transoral and transnasal approaches
The second case: (A) sagittal CT scan showed that the bullet was located at the cranial ridge junction region; (B) intraoperative image of the bullet under the endoscopy. (C) sagittal CT scan confirmed the removal of the bullet (the arrows show the location of the bullet). CT = computed tomography.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998485&req=5

Figure 2: The second case: (A) sagittal CT scan showed that the bullet was located at the cranial ridge junction region; (B) intraoperative image of the bullet under the endoscopy. (C) sagittal CT scan confirmed the removal of the bullet (the arrows show the location of the bullet). CT = computed tomography.
Mentions: The second case was a 36-year-old man who was admitted to our hospital on Mar 09, 2015, that had been 17 days after being shot in the face on Feb 20, 2015. The patient was awake and alert without conscious disturbance, airway and neck activity difficulties, and neurovascular compromise. The bullet had passed into the right alveolar process of the upper jaw bone and had broken the alveolar bone. CT scan showed a foreign body lodged in the soft tissues before the right anterior arch of Atlas cone (C1) that presented a fracture, without the vertebral artery and odontoid damaged. Under general anesthesia, transoral and transnasal visualization was achieved by using a 4-mm zero-degree nasal endoscope. An incision was made in the right side of the retropharyngeal wall. After careful dissection of the adjacent tissues, the bullet was fully found and taken out. Compression hemostasia was used at the operating field. The patient was then discharged without neck activity obstacle. One month later, CT scan confirmed the disappearance of the foreign body and the stability of the cervical vertebra (Fig. 2). This study was approved by the ethics committee of Southwest Hospital (Chongqing, China) and the informed consent was obtained from the patients.

View Article: PubMed Central - PubMed

ABSTRACT

Endoscopes in otolaryngology may facilitate accessing the lumens and sites such as upper cervical spine with minimally invasive surgical exposure. Here, we present 2 interesting cases of youth who underwent endoscopic removal of bullets in the cranial ridge junction region.

The first case was a 20-year-old young man who underwent a gunshot in the face. A CT scan showed that a metallic foreign body located inside the right lateral body of Atlas that presented a comminuted fracture. The second case a 36-year-old man who also underwent a gunshot in the face. CT scan showed a foreign body lodged in the soft tissues before the right anterior arch of Atlas cone (C1) that presented a fracture. The bullets in these 2 patients were removed under the endoscopes with minimal damage, respectively. The patients were discharged without neck activity obstacle.

The advantage of endoscopic technique is obvious because limited visualization does not damage surrounding tissues, thus decreasing surgical complications. This was an interesting experience of surgical operation in this region.

No MeSH data available.