Craniofacial wound from a traumatic pistol injury in a 3-year-old child

With the advent of traumatic self-defense weapons among Russian civilians (weapons of limited destruction and nonlethal kinetic weapons), several studies on injuries among the adult population have been published in the medical literature. Skull injuries are the most severe, often fatal, injuries. To date, there are only isolated descriptions of such injuries in children.

Description of the observation. According to the parents, the 3-year-old boy shot himself in the face with an Osa-4 pistol at home. He did not lose consciousness, and the bleeding was light. He was admitted to the central district hospital, from where he was evacuated by an ambulance team to Children’s City Clinical Hospital No. 9 named after. G.N. Speransky, Moscow. Upon admission, the patient was in a serious condition, conscious, and lethargic, reacted negatively to examination, and had 14 points on the Glasgow coma scale, and his hemodynamics was stable. Local status: In the upper part of the dorsum of the nose, a bullet entry hole was observed in the form of a bruised wound of irregular shape, pronounced swelling in the area of the left orbit, and hematoma of the upper eyelid. X-ray images of the skull showed a shadow of a foreign body (bullet) in the projection of the left orbit and ethmoidal labyrinth. The location and extent of damage were clarified by computed tomography. Under endotracheal anesthesia, a supraorbital trans-eyebrow approach on the left with layer-by-layer tissue dissection along the wound canal exposed a part of the bullet, wedged into the medial wall of the orbit and cells of the ethmoid bone. The bullet was removed, and bone fragments and layer-by-layer sutures were removed. Diagnosis: Gunshot causing a blind craniofacial non-penetrating wound in the dorsum of the nose and left orbit, multiple comminuted fractures of the ethmoid bones and superior and medial walls of the left orbit, contusion of the basal parts of the left frontal region of the brain, blunt trauma OS stage 2, local contusion, and retinal hemorrhage The postoperative period passed without complications. The child received a combination of antibacterial and restorative therapy. Vision was preserved, no neurological disorders were detected, and the cosmetic result was good. The patient was discharged in satisfactory condition under the supervision of an ophthalmologist, neurologist, and maxillofacial surgeon. This observation is presented to demonstrate damage to skull structures from traumatic weapons and will aid in further generalization of the treatment results of this type of wound in children. Prevention of injuries in children from traumatic weapons requires extensive educational work among parents who own these weapons.