Indirect gunshot wound to the head.
BACKGROUND
An Afghani man presented to a U.S. military facility in Afghanistan with a 3-month history of clear fluid from his left naris and frequent sinusitis. Eleven years earlier, he had been struck in the forehead by an object falling from the sky.


METHODS
Neurologic examination revealed decreased sensation in V1 and V2 on the left side. Imaging revealed a large bullet lodged in the left maxillary sinus.


RESULTS
The bullet was removed via sublabial incision and opening of the anterior bony wall of the maxillary sinus.


CONCLUSIONS
In Afghanistan, indirect gunshot wounds to the head are not uncommon because of the constant war conditions since the invasion by the former Soviet Union in 1979 and the tradition of firing rounds into the air during cultural celebrations.
Ragel
Brian T
BT
Department of Neurosurgery, David Grant Medical Center, 101 Bodin Circle, Travis AFB, Fairfield, CA 94535, USA, brian.ragel@gmail.com
McCafferty
Randall R
RR
D000328:Adult; D000346:Afghanistan; D005624:Frontal Bone / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D020197:Head Injuries, Penetrating / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology; D015523:Maxillary Sinusitis / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D008889:Military Personnel; D019635:Neurosurgical Procedures; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods; D011859:Radiography; D019651:Plastic Surgery Procedures; D012678:Sensation Disorders / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D019291:Skull Base / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D020205:Skull Fracture, Basilar / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome; D020433:Trigeminal Nerve Diseases / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D014948:Wounds, Gunshot / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology