Influence of Different Types of Guns, Projectiles, and Propellants on Patterns of Injury to the Viscerocranium

Abstract

Gunshot injuries to the oral and craniomaxillofacial region vary with the type of gun used. Computed tomography (CT) is the standard diagnostic tool for assessing tissue damage in patients with gunshot injuries. Cone-beam computed tomography (CBCT) is a new imaging technique that has recently become available for clinical diagnosis. The objective of this study was to characterize injury patterns with a focus on gun types and identify the imaging modality that is best suited to assessing injuries caused by different gun types. We present the cases of 14 patients who sustained gunshot injuries to the viscerocranium during the past 10 years. The injuries were caused by 8 basic combinations of handguns or long guns with soft lead core projectiles, partial or full metal-jacketed bullets, and different propellants. Diagnosis was based on clinical and radiological findings (including CT and CBCT). We found a direct correlation between the gun/projectile combination on the one hand and the diameter of the wound track, tissue contamination, and tissue destruction on the other. Entrance and exit wounds are indicative of certain gun/projectile combinations. High-density projectiles cause severe artifacts in CT, unlike CBCT, making it difficult to evaluate anatomic structures in close proximity to the projectile. Every gun/projectile combination is associated with a typical pattern of injury. Even in the absence of the offending projectile, it is thus possible to narrow down the likely gun and/or projectile. In the diagnostic imaging of injuries caused by high-density projectiles, CBCT is more suitable than CT.