Mandibular gunshot wound with bullet aspiration

Urban violence continues to be an important source of penetrating craniofacial injuries in major trauma centers. Gunshot wounds to the mandible are a commonly treated condition by craniofacial surgeons. Some gunshot wounds are through-and-through injuries, but in many patients, the bullet enters with no visible exit wound. In such situations, the bullet's trajectory and final destination are certainly important to the craniofacial surgeon in the extent of bony damage but may also be of unforeseen consequence to the patient's airway and respiratory condition. We present a case of a patient who had a gunshot wound to the face with comminuted mandibular ramus fracture in which the bullet was unexpectedly found to be aspirated down the right mainstem bronchus. This is the first reported case of a completely intact bullet being aspirated after gunshot wound to the face in an adult patient. We present this case to illustrate a rare possible complication after penetrating mandibular injury and offer a strategy for management of such an occurrence.