title: Craniofacial gunshot injuries: an unrecognised risk factor for blunt cervical vascular injuries?
abstract: OBJECTIVE
  To review our institutional experience with cervical arterial injuries remote from the penetrating tract seen in the setting of craniofacial gunshot injuries.
  
  
  METHODS
  Institutional Review Board approval was obtained. Our institutional trauma registry was queried over a 5-year period for patients with cervical arterial injuries due to penetrating craniofacial gunshot wounds who underwent CT angiography. Imaging results and clinical notes were reviewed.
  
  
  RESULTS
  A total of 427 patients sustained gunshot wounds to the head, face and/or neck, of whom 222 underwent CT angiography yielding 56 patients with 78 vascular injuries. There were five internal carotid artery injuries remote from the wound tract. The incidence of these "indirect" cervical arterial injuries in our patient population was 1.2%, or 2.8% of patients who underwent CT angiography.
  
  
  CONCLUSIONS
  The incidence of "indirect" cervical arterial injuries with craniofacial gunshot wounds is comparable to or slightly higher than those seen in pure blunt trauma. Screening patients with craniofacial gunshot injuries with CT angiography may yield unexpected cervical vascular injuries remote from the penetrating tract. The significance and optimal therapy of these injuries are unknown. Additional experience will be needed to determine the significance of "indirect" cervical arterial injuries in the setting of craniofacial gunshot wounds.
authors.affiliation: Diagnostic Imaging Department, University of Maryland Medical Center and R Adams Cowley Shock Trauma Center, 22 S Greene St, Baltimore, MD 21201, USA. ssteenbu@iuhealth.org
authors.forename: Scott D
authors.initials: SD
authors.lastname: Steenburg
authors.forename: Clint W
authors.initials: CW
authors.lastname: Sliker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000706:statistics & numerical data*; D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015897:Comorbidity; D006259:Craniocerebral Trauma / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005151:Facial Injuries / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008396:Maryland / Q000453:epidemiology; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D014948:Wounds, Gunshot / Q000000981:diagnostic imaging / Q000453:epidemiology*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging / Q000453:epidemiology*; D055815:Young Adult