| Volume 2003, Issue 2, Article 1 |
|
Meagher, Shah. |
Numerous co-morbidities were identified within the 4 patient populations. The preponderance were manifest in the intentionally self-inflicted population and included a history of significant mental illness, such as Bipolar Disorder, Schizophrenia, Depression, and psychosis not otherwise specified. These patients also possessed histories punctuated by alcohol abuse, alcoholism, and poly-substance abuse. Alcohol abuse, alcoholism, and ADHD were identified within the patient population intentionally injured by another.
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Figure 9, A-C: Long range shotgun injury intentionally inflicted by another. A frontal blast at long range covers a large area of face with direct penetrating injury at both orbits. However, the missile fragments are stopped by the zygoma and orbital bones. Only one bullet penetrates the calvarium and lodges in to right superior orbital fissure in to right temporo-occipital lobe trailing bone fragments and hemorrhage.
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Figure 10, A-C: Intentionally self-inflicted BB gun injury. Barrel was pointed medially and superiorly at the inner canthus of right orbit. The orbital globe is intact. Soft tissue and orbital muscle injury were seen. Low-velocity BB is lodged in the roof of the sphenoidal sinus on the right side with fracture and dural tear resulting in extensive pneumocephalus, but no direct brain injury.
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Figure 11, A-D: Intentionally self-inflicted 12 gauge shotgun injury, barrel below the chin. This is a follow-up study after a maxillary reconstruction plate seen in 3D reformats. Note the total lack of mandible, maxilla, hard palate, ethmoids and frontal sinuses in the midline. Orbits are well preserved bilaterally.
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Figure 12, A-C: Intermediate-range lethal handgun injury intentionally inflicted by another. Left frontal entry wound with the bullet lodged just below a fractured right parietal bone. Bone fragments, bullet fragments, vapor bubble, and hemorrhage seen along the path of the bullet. Interhemispheric, intraventricular, and subdural hemorrhages are seen with a low-attenuating swollen brain. There was effacement of the basal cistern with transtentorial herniation.
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Figure 13, A-C: Close-range lethal intentionally self-inflicted handgun injury. Right frontal entry wound with fracture of the frontal bone in the midline, but bullet ricocheting off the skull and lying at left temporo-parietal lobe. Note extensive parenchymal, subdural, subarachnoid, and interhemispheric hemorrhage. Bone fragments at right frontal lobe.
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Figure 14, A-C: Close-range intentionally self-inflicted handgun injury. Entry wound over right temple, but gun was pointed anteriorly. It blew off the right orbital globe completely and lodged in the nasal cavity, sparing the brain. Note bullet fragments at right orbit with a bony defect of entry wound at superior part of lateral wall.
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Figure 15, A-F: Intentionally self-inflicted hunting rifle (.36 caliber) injury, barrel below the chin. The path of the bullet is oblique, starting below right mandible and almost completely destroying the face and both the orbits. There are numerous fracture starting with the right mandible, bones of the midface, paranasal sinuses, and bilateral bony orbits. Bullet fragments are seen at left orbit. However, compared to a shotgun injury damage is greater but over a smaller area. There was no brain injury.
Gunshot injuries to the face and cranium can be devastating. For patients with intentionally self-inflicted injuries, handguns appear to be more lethal than either rifles or shotguns. This may be secondary to the length and awkward nature of the barrel with both the shotgun and rifle. Difficulty in reaching the trigger while keeping the barrel pointed toward the brain may also play a role. Shotgun and rifle injuries do, however, appear to cause more extensive damage to both the soft tissues and bones of the face. Shotguns appear to cause widespread damage to facial structures, while rifles focus more of their destructive power centrally in the path of the bullet. Despite their apparently higher lethality, handguns, too, can cause significant facial destruction if positioned inappropriately.
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