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1. Under Fire : A Case report on Gunshot Injury Dr. A. R. Thennarasu, MDS (CMFS) Consultant Cleft and craniofacial Surgeon Kavan Hospital

2. Introduction Gun shot injuries to the maxillofacial region in particular present a challenging situation for the facial reconstructive surgeon . These injuries are rare and hence the true incidence is unknown . Currently Gun shot injuries are classified as Penetrating Perforating Avulsive Blast “Chop off ” Injuries

3. Management of Gunshot Injuries Establishing an airway Control of Hemorrhage Damage control surgery and identifying concomitant injuries Early Definitive repair of hard and soft tissues Aesthetic refinements and rehabilitation

4. Case Discussion Patient name:- Mr. Chandu Age/sex:- 24 years/M Chief complaint:- Patient complaints of pain and swelling in right lower half of the face.

5. History of presenting illness:- Patient gives alleged H/O of accidental injury while exploring a rifle of his grand father on 22/03/25 @ 3.45 PM near Chengam . H/O Pain and Swelling in right lower half of the face. H/O Difficulty in mouth opening. H/O fever for past 1 day.

6. Past medical History First aid was done in a small clinic near Uthangarai and referred to Kavan Hospital for further treatment. Past Surgical History No relevant History

7. General examination Patient is concious , Vitals are stable. GCS: 15/15 Patient is moderately built and nourished. No signs of Icterus, pallor, cyanosis, clubbing and pedal oedema. Systemic examination: Normal

8. Clinical Examination Facial Asymmetry noted in the right side of the mandible. Diffuse swelling noted in the right side of the ramus of the mandible measuring about 2 x 2 cm, which is hard in consistency, Tender on palpation, Non compressible on palpation, multiple foreign body noted while palpation. No ulceration or discharge present extra orally. Eye ball movements normal TMJ movements normal

9. Clinical Examination Intra orally – Ulcerated deep necrotic wound noted in the retromolar region which measures about 2.5 x 2 cm, extends anteriorly distal to first molar, posteriorly to retromolar trigone, medially to floor of the mouth and laterally to the buccal mucosa of 47, black in colour, Tender on palpation, Pus Discharge present. Burnt laceration noted in right corner of the lip. On Palpation multiple foreign bodies noted. Occlusion Intact. Mouth opening restricted (2 fingers).

10. Investigations OPG reveals multiple radio opaque objects noted in the right Angle and ramus of the mandible region.

11. Investigations CT facial bone reveals multiple radio opaque objects noted in the right Angle and ramus of the mandible region.

12. Diagnosis Rifle Injury/ Multiple foreign Body (Shot gun pellets) in Right Buccal Mucosa

13. Treatment Plan Extraction of Foreign body (Shot gun pellets) under GA

14. Intra Operative

15. Intra Operative

16. Postop x - ray

17. Conclusion The management strategies of patients with facial gunshot wounds are almost as diverse as the case presentation itself. The ideal time to treat these type of gun shot injuries is within 48 hrs .

18. Thank You