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  • Title: Management of penetrating war injuries: bullet/shell fragments in the sphenoid sinuses.
    Author: Shuker ST.
    Journal: J Oral Maxillofac Surg; 2008 Oct; 66(10):2067-72. PubMed ID: 18848104.
    Abstract:
    PURPOSE: Penetrating sphenoid sinus injuries in both war and civilian practice are rare. A review of the literature shows no reports of shell fragments or bullets in this region; hence, the rarity of the cases prompted this report. MATERIALS AND METHODS: A variety of surgical approaches--transethmoidal, transnasal trans-septal, sublabial transnasal, and endoscopic techniques--and the feasibility, efficacy, and safety of these techniques used in the delivery and management of missiles lodged in the sphenoid sinus under conditions of war are described. RESULTS: Four shell fragments and 2 bullets were removed without increasing morbidity and with avoidance of unnecessary trauma to the area affected by the missile. CONCLUSIONS: In this series of patients with war missile injuries settled in the sphenoid sinus/base of the skull undergoing surgical treatment, there were no major intraoperative or postoperative complications. Differentiation in the approaches to this anatomic region is necessary based on whether there is a tumor or penetrating war injury.
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