Atypical Gunshot Injury Traversing the Neck with an Unexpected Nonlinear Bullet Trajectory: a Case Report and Review of the Literature

AbstractGunshot injuries involving the head and neck region yield profound morbidity and mortality rates. Projectile-related factors comprising various physical and dynamic properties of a bullet, as well as tissue-related factors, determine the disruptive effects of projectiles on living tissues. We experienced an extremely unusual case of a gunshot injury to the neck, wherein the bullet transversely penetrated across the deep neck structures to the contralateral side of the shoulder without damaging any vital organs. A 51-year-old man presented with a gunshot wound to the neck from a point-blank range. A bullet entry hole was observed on the left side of the neck without an exit hole; however, the patient was conscious, vital signs were normal, and no active bleeding, cranial nerve palsy, or aero-digestive tract injury was found. Imaging tests revealed a bullet lying in front of the right humeral head, which was extracted by emergency surgery. The patient was uneventfully discharged. According to the localization of the damaged tissues and the positional relationship between the bullet’s entrance and its destination, the bullet was estimated to have nonlinearly traversed the neck by traveling through the interstructural spaces associated with the least tissue resistance. Our experience strongly suggests the importance of realizing the unpredictable nature of a bullet trajectory in a body. An appropriate understanding of various ballistic factors and wounding mechanisms can be of great help in the adequate assessment and management of patients with gunshot injuries.

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Atypical gunshot injury to the neck with an unexpected nonlinear bullet trajectory: a case report and review of the literature

10.21203/rs.2.22843/v1 ◽

2020 ◽

Author(s):

Yuuki Matsui ◽

Sena Iguchi ◽

Emiri Sato ◽

Yoichiro Sato ◽

Ken Shindo ◽

...

Keyword(s):

Dynamic Properties ◽

Body Movement ◽

Neck Region ◽

Body Awareness ◽

The Body ◽

Gunshot Injury ◽

Retropharyngeal Space ◽

Related Factors ◽

Gunshot Injuries ◽

The Right

Abstract Background Gunshot injuries involving the head and neck region yield profound morbidity and mortality rates because of the region’s dense structure occupied with essential organs. Both projectile- and tissue-related factors determine the disruptive effects of projectiles on living tissues, with the former comprising various physical and dynamic properties of a bullet. Although a bullet generally passes straight through the body, we experienced an unusual case of a gunshot injury to the neck, wherein the bullet penetrated through the deep structures to the contralateral side of the shoulder without damaging any vital organs, allowing us to discuss the diagnostic implications of wound ballistics in managing gunshot wounds with unexpected bullet trajectories. Case presentation A 51-year-old man presented with a gunshot wound to the neck from a point-blank range shooting during a local gang conflict. On admission, a bullet entry hole was observed on the left side of the neck without an exit hole; however, the patient was conscious; vital signs were normal; and no active bleeding, cranial nerve palsy, or aero-digestive tract injury were found. Imaging tests revealed a bullet lying in front of the right humeral head, a comminuted fracture of the right clavicle, and soft tissue edema and small air sacs among the deep neck structures, including the retropharyngeal space. Emergency surgery was performed to extract the bullet, which turned out to be a full metal-jacketed bullet. Five days later, the patient was uneventfully discharged. According to the localization of the damaged tissues and the positional relationship between the bullet’s entrance and its destination, we estimated that the bullet nonlinearly penetrated the neck through the interstructural spaces associated with the least tissue resistance, almost transversely, during its intra-body movement. Conclusion Our experience strongly suggests the importance of realizing the unpredictable nature of a bullet trajectory in a body. Awareness of various ballistic factors and wounding mechanisms, which affect a bullet trajectory and the magnitude of tissue damage, can be of great help in adequate assessment and management of patients with gunshot injuries.

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Three Cases of Variation Muscle Bundles, that Arise from the Second Costa and Insert to the Medial Border of the Scapula Bilaterally, and that Passes Down ward in the Right Posterior Neck Region

The Journal of the Kyushu Dental Society ◽

10.2504/kds.29.224 ◽

1975 ◽

Vol 29 (3) ◽

pp. 224-227

Author(s):

Atsushi Rokutanda ◽

Yasuhiro Fukamizu ◽

Kazuo Mizuki ◽

Masayoshi Kaji

Keyword(s):

Neck Region ◽

Medial Border ◽

Posterior Neck ◽

The Right

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Measuring Earwax Cortisol Concentration Using a Non-Stressful Method (Preprint)

10.2196/preprints.19383 ◽

2020 ◽

Author(s):

Andrés Herane-Vives

Keyword(s):

Cortisol Level ◽

Local Stress ◽

Extraction Methods ◽

Cortisol Concentration ◽

The Novel ◽

Sampling Device ◽

Related Factors ◽

Novel Device ◽

Cortisol Levels ◽

The Right

BACKGROUND “Short-term” samples are not the most appropriate for reflecting Chronic Cortisol Concentration (CCC). Although hair is used for reflecting the systemic cortisol level over “long-term”, its use appears clinically problematic. Local stress and non-stress related factors may release a circumscribed cortisol secretion that is accumulated in hair. Non-stressful earwax extraction methods may provide a more accurate specimen to measure CCC. OBJECTIVE Correlate cortisol levels using hair, serum and earwax samples METHODS Earwax from both ears of 37 controls were extracted using a clinical procedure commonly associated with local pain. One month later, earwax from the left ear side was extracted using the same procedure, and earwax from the right ear side was comfortably extracted, using an earwax self-sampling device. Participants also provided one centimetre of hair that represented the retrospective month of cortisol output, and one serum sample that reflected the effect of systemic stressors on cortisol levels. Earwax (ECC), Hair (HCC) and Serum (SCC) Cortisol Concentration were correlated and compared. Confounders´ effect on cortisol levels were studied. RESULTS Serum showed the largest and hair the lowest cortisol concentration (p<0.01). Left-ECC was larger than Right-ECC (p=0.03). Right-ECC was the only sample unaffected by confounders (all p>0.05). Right-ECC and HCC showed the only significant association (r=0.39; p=0.03). CONCLUSIONS The self-sampling device did not represent a local stressor for the ceruminous glands. It provided the cortisol level with the least likely to be affected by confounding factors over the previous month. ECC using the novel device may constitute another accurate, but more suitable and affordable specimen for measuring CCC.

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Smartphone addiction and the relationship with head and neck pain and electromiographic activity of masticatory muscles

Work ◽

10.3233/wor-203398 ◽

2021 ◽

pp. 1-8

Author(s):

Fabiana Foltran Mescollotto ◽

Érica Brito Gonçalves ◽

Ester Moreira de Castro Carletti ◽

Ana Beatriz Oliveira ◽

Elisa Bizetti Pelai ◽

...

Keyword(s):

College Students ◽

Neck Pain ◽

Head And Neck ◽

Muscle Activity ◽

Neck Region ◽

Masticatory Muscles ◽

Smartphone Addiction ◽

Before And After ◽

Smartphone Use ◽

The Right

Background: Excessive use of smartphones may be associated with behavioral and physical health changes and might cause musculoskeletal alterations in the head and neck region. Objective: To evaluate the prevalence of smartphone addiction in college students and its correlation with symptoms of head and neck pain and masticatory and trapezius muscle activity while resting, before and after smartphone use. Methods: Twenty university students participated in the study. They answered the Smartphone Addiction Scale and the Fonseca Anamnestic Index. Next, the participants were seated and prepared for electromyography through the placement of surface electrodes on the masseter, temporal, and trapezius muscles. Rest condition data were collected for 10 seconds before and after 30 minutes of smartphone use. Results: The results showed that 35% of the evaluated individuals were classified as smartphone addicted and 35% reported no head or neck pain in the previous 30 days. There was no association between smartphone use and head and neck pain. In the electromyography, there was an increase in RMS values after smartphone use in the right and left masseter muscles and the left trapezius. Conclusion: College students presented a high prevalence of smartphone addiction and head and neck pain, but these were not statistically associated. There was a change in muscle activity only in the right trapezius muscles before and after 30 minutes of smartphone use. These findings are contrary to the current belief that the use of smartphones correlates with pain in the neck region and changes in the electrical muscle activity, leading to fatigue in the cervical muscles.

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Cervical Sympathetic Trunk-Centered Inflammatory Myofibroblastic Tumor Complicated with Postoperative First Bite Syndrome

Indian Journal of Surgery ◽

10.1007/s12262-021-02869-0 ◽

2021 ◽

Author(s):

Liu Yang ◽

Wen Li

Keyword(s):

Neck Region ◽

Sympathetic Trunk ◽

Cervical Sympathetic Trunk ◽

First Line Therapy ◽

Normal Limits ◽

Serum Igg4 ◽

Postoperative Serum ◽

Cervical Sympathetic ◽

The Right ◽

First Bite Syndrome

AbstractInflammatory myofibroblastic tumors (IMTs) in the head and neck region are common, but those with sympathetic trunk involvement are extremely rare. Here we present a case of cervical sympathetic trunk-centered IMT which is also accompanied by ipsilateral carotid artery, internal jugular vein, and vagus nerve involvement. The patient initially complained of an episodic painful swelling on the right side of the neck and underwent surgery. Preoperative and postoperative serum IgG4 level during 3-year follow-up time is within normal limits. Immunohistochemical study of the tumor has also revealed negativity to IgG4. Postoperative first bite syndrome (FBS) was observed. Surgery seems to be first-line therapy in the patient with IgG4-negative IMT.

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Desmoplastic Small Round Cell Tumor of the Submandibular Gland: A Case Report and Literature Review

ORL ◽

10.1159/000517563 ◽

2021 ◽

pp. 1-6

Author(s):

Qingjiao Li ◽

Xiaolu Yuan

Keyword(s):

Submandibular Gland ◽

Young Patients ◽

Neck Region ◽

Cell Tumor ◽

Pelvic Cavity ◽

Round Cell ◽

Round Cell Tumor ◽

Small Round Cell Tumor ◽

Small Round Cell ◽

The Right

Desmoplastic small round cell tumor (DSRCT) is a rare and aggressively malignant tumor mostly occurring in the abdominal and pelvic cavity of young patients. However, few cases had been reported concerning DSRCT occurring in the head and neck region. We presented a rare case of DSRCT of the right submandibular in a 25-year-old man. MRI revealed a 3 × 2-cm solid nodule located in the right submandibular, and physical examination showed no other occupying lesion elsewhere. Histologically, the tumor was composed of various-sized small round cell nests, embedded in an abundant desmoplastic stroma. Immunohistochemically, the tumor cells were typically positive for epithelial (CK and EMA), mesenchymal (vimentin and desmin), and neuroendocrine (CD56, NSE, Syn, and CgA) markers, but negative for WT1. Fluorescence in situ hybridization revealed the presence of a break apart involving the Ewing sarcoma (EWS) gene. The patient received chemotherapy and radiotherapy and relapsed after 19 months of follow-up. DSRCT of the submandibular gland is rare, and the diagnosis of this tumor in an uncommon location relies on the histomorphology, immunophenotype, and EWS gene translocation detection. Differential diagnosis including primary salivary gland tumors and the other small round cell tumors needs to be excluded.

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Anomalous Origin of the Right Coronary Artery From Contralateral Side: A Series of 17 Cases

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2013.08.646 ◽

2013 ◽

Vol 62 (18) ◽

pp. C228

Author(s):

Sedat Köroğlu ◽

Arif Suner ◽

Cemal Tuncer ◽

Ahmet Akcay ◽

Alper Nacar ◽

...

Keyword(s):

Coronary Artery ◽

Right Coronary Artery ◽

Contralateral Side ◽

Anomalous Origin ◽

The Right

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A RARE CASE OF RECURRENT ADENOID CYSTIC CARCINOMA OF THE BUCCAL MUCOSA

10.36106/ijsr/3714486 ◽

2021 ◽

pp. 1-2

Author(s):

Surya Rao Rao Venkata Mahipathy ◽

Alagar Raja Durairaj ◽

Narayanamurthy Sundaramurthy ◽

Anand Prasath Jayachandiran ◽

Suresh Rajendran

Keyword(s):

Adenoid Cystic Carcinoma ◽

Buccal Mucosa ◽

Malignant Neoplasm ◽

Neck Region ◽

Surgical Excision ◽

Minor Salivary Glands ◽

Head And Neck Region ◽

Adenoid Cystic ◽

The Right ◽

Carcinoma Buccal Mucosa

Adenoid cystic carcinoma is a malignant neoplasm most commonly originating in the minor salivary glands of head and neck region. Among intra oral adenoid cystic carcinoma, buccal mucosa is one of the rarer sites. Here, we report a case of recurrent adenoid cystic carcinoma of the right buccal mucosa in a 33 year old female. As this is an uncommon site for adenoid cystic carcinoma, it should be considered as a differential diagnosis of mass of buccal mucosa. It is imperative that we identify such cases and plan for early surgical excision with adequate margins.

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Iatrogenic hydrohemothorax during percutaneous nephrolithotomy: A case report

Open Access Research Journal of Multidisciplinary Studies ◽

10.53022/oarjms.2021.1.2.0011 ◽

2021 ◽

Vol 1 (2) ◽

pp. 079-082

Author(s):

Tae Yeon Kim ◽

Kyu Nam Kim ◽

Lee Kwang Hyun ◽

Bo Seok Kwon ◽

Jo Hyung Jun

Keyword(s):

Percutaneous Nephrolithotomy ◽

Renal Stone ◽

Vital Signs ◽

Pulmonary Complications ◽

Fluid Retention ◽

Air Bubbles ◽

Close Cooperation ◽

The Right ◽

Pleural Injury ◽

Routine Chest

Background: Percutaneous nephrolithotomy (PNL) is a widely used surgical method for renal stone management. However, it can be associated with several complications. Case: We report an acute hemothorax during PNL in 57-year-old male patient with a stone. After observing air bubbles at the diaphragm on the laparoscopic screen, we considered pulmonary complications. A chest radiograph demonstrated a shade that measured 130 mm wide and 70 mm long and fluid retention on the right side of the chest. During drainage of 200 ml of blood through a chest tube, the patient’s vital signs became unstable. After the patient received hydration and intravenous injection of vasopressor, his vital signs stabilized. Conclusions: Pulmonary complications due to pleural injury during PNL can result in death, but the complications can be managed by early diagnosis and treatment. Close cooperation between surgeon and anesthesiologist and routine chest radiographs after PNL can reduce the pulmonary complications.

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