Ballistic Injury

Ballistic injuries are injuries sustained from the discharge of arms or ammunitions. Treatment of these wounds includes management of both soft tissue injuries and fractures of bones. Craniofacial Ballistic injuries are successfully treated and reconstructed at our hospital

Case 1

Iraqi soldier’s eye saved after bullet injury

An Iraqi soldier was maimed by a stray bullet in a civil unrest in Baghdad. The bullet entered the head at the nape of the neck, travelled through the base of the skull and exited just below the lower eyelid damaging the right upper jaw, eye bones and mid face. He was given first aid and subsequently brought to Balaji Dental & Craniofacial Hospital, Chennai for reconstruction of the face wherein he underwent successful rehabilitation.

Few months before the accident

Few months before the accident

Bullet entry and exit wound

Bullet entry and exit wound

Path of the bullet leading to fracture of the upper jaw, eye bone and sinus

Path of the bullet leading to fracture of the upper jaw, eye bone and sinus

Reconstruction of eye socket floor using Titanium mesh and cartilage graft from patient's rib

Reconstruction of eye socket floor using Titanium mesh and cartilage graft from patient's rib

Before and after surgery

Before and after surgery

The patient with Dr. S.M. Balaji at the time of discharge

The patient with Dr. S.M. Balaji at the time of discharge

Stray bullet passes close to eye

A 21-year-old male Iraqi soldier Hassanain Ibrahim Noori was severely wounded in a gunshot accident. During a civil unrest in Baghdad, unidentified miscreants shot at random and the victim was caught in the line of fire.

A close range bullet shot at medium or intermediate velocity, entered his skull at the nape of the neck, travelled through the base of the skull and exited just below the right lower eyelid severely damaging the eye socket, lower eyelid, cheek bone and upper jaw on the right side of the face. The intensity of the injury caused the right eye to hang low. He had a miraculous escape of life when the bullet narrowly missed two major arteries in the skull.

He was taken to a hospital nearby where he was given first aid only. He was further referred to Balaji Dental and Craniofacial Hospital for expert treatment and facial reconstruction.

Eminent Facio-Maxillofacial Surgeon Dr. S.M. Balaji carefully analyzed the ballistics injury. A CT scan was taken to gauge the extent of complexity. The bullet had damaged the soft tissue and bone of the upper jaw including the floor of the eye socket as well as parts of the lower eyelid.

A diligent and intricate surgical procedure was performed by the surgical team headed by Dr. Balaji to restore normal function and appearance. The right eyeball was lifted and a Titanium mesh was placed to reconstruct the floor of the right eye socket. A bone graft was taken from the patient’s ribs and was used to accurately re-contour the smashed right cheek and eye bone. Hassanain’s facial appearance and eyesight were restored to normalcy, thanks to the accomplished efforts of Dr. Balaji and his team. A much delighted Hassanain and his family returned to Iraq.

The patient and his mother thanking Dr. Balaji

The patient and his mother thanking Dr. Balaji

Case 2

Surgical closure of palatal fistula from shrapnel injury

Palatal fistula following the trauma

Palatal fistula following the trauma

Temporalis myofascial flap used to close the defect

Temporalis myofascial flap used to close the defect

Flap sutured firmly in place

Flap sutured firmly in place

Complete closure of defect and good healing seen after surgery

Complete closure of defect and good healing seen after surgery

A 35-year-old woman came to our hospital seeking treatment for a defect in the roof of her mouth. She complained of escape of foods and fluids from the mouth through the nose and a nasal-sounding speech. She had a large palatal fistula in the roof of her mouth causing a communication between the nose and mouth. She also had a scar on her left cheek. She gave a history of having been an unfortunate victim of civil riots several months ago wherein she sustained a shrapnel injury to her upper jaw. She had sought immediate first aid elsewhere.

The extent of the defect was evaluated using advanced 3D CT scan. Dr. S.M. Balaji successfully reconstructed the palatal fistula defect covering it with a Temporalis myofascial flap. Following surgery, the patient’s symptoms ceased and her quality of life improved.