Bullet lodged in the neck!
How would you start treating it?
These head and neck radiographs depict an atypical, accidental AK-47 rifle injury to the right side of the face and neck. The anteroposterior view on the left shows the bullet in the right side of the neck, as well as a comminuted fracture of the mandible (angle and ramus) and maxillary antrum.
The lateral radiograph on the right also reveals the bullet lodged in the neck, anterior to the bodies of the cervical vertebrae 6 and 7.
Gunshot wounds to the neck are highly likely to cause significant injury. Previously, injuries that violated the platysma muscle were thought to require surgical neck exploration; however, because a large number of these neck explorations were ‘’negative’’, advanced imaging in stable patients prior to surgical exploration appears to be a reasonable approach.
Cervical spine immobilization is not typically recommended in penetrating neck trauma. However, high-force mechanisms, such as a gunshot wound, make cervical spine injury more likely. Therefore, clinicians should consider immobilizing the cervical spine.