Penetrating gunshot wound to the head: transotic approach to remove the bullet and masseteric-facial nerve anastomosis for early facial reanimation.
BACKGROUND
Gunshot wounds to the head (GSWH) account for the majority of penetrating brain injuries, and are the most lethal. Since they are rare in Europe, the number of neurosurgeons who have experienced this type of traumatic injury is decreasing, and fewer cases are reported in the literature.


METHODS
We describe a case of gunshot to the temporal bone in which the bullet penetrated the skull resulting in the facial nerve paralysis. It was excised with the transotic approach. Microsurgical anastomosis among the masseteric nerve and the facial nerve was performed.


CONCLUSIONS
GSWH are often devastating. The in-hospital mortality for civilians with penetrating craniocerebral injury is very high. Survivors often have high rate of complications. When facial paralysis is present, masseteric-facial direct neurorraphy represent a good treatment.
Sapienza University of Rome, Department of Neurosurgery, Rome, Italy.
Pasquale
P
Donnarumma
Roberto
R
Tarantino
Paolo
P
Gennaro
Valeria
V
Mitro
Valentino
V
Valentini
Giuseppe
G
Magliulo
Roberto
R
Delfini
D000714:Anastomosis, Surgical / Q000379:methods*; D005154:Facial Nerve / Q000601:surgery*; D005158:Facial Paralysis / Q000209:etiology / Q000601:surgery*; D020197:Head Injuries, Penetrating / Q000209:etiology / Q000601:surgery*; D006801:Humans; D008297:Male; D008406:Masseter Muscle / Q000294:innervation*; D008875:Middle Aged; D013406:Suicide, Attempted; D014948:Wounds, Gunshot / Q000601:surgery*