Orbitozygomatic approach for bullet retrieval from the temporal fossa

Area of Science:

• Neurosurgery
• Ophthalmology
• Trauma Surgery

Background:

• Periorbital gunshot wounds (PGWs) present significant challenges due to potential ophthalmic and orbital structure damage.
• Bullet retrieval in the orbit is complex due to limited space and critical anatomical structures.

Observation:

• A 34-year-old female sustained a right orbital gunshot wound with a fragment lodged at the temporalis fossa-skull base junction.
• The bullet traversed the globe and orbit before lodging in the temporal fossa.

Findings:

• An orbitozygomatic approach was utilized for fragment retrieval.
• This technique allowed dissection through the superior orbital fissure to the temporal fossa.
• Multiple fragments were removed, and a cerebrospinal fluid leak was sealed.

Implications:

• The orbitozygomatic approach is effective for complex orbital gunshot wounds extending to the temporal fossa.
• This approach minimizes risk to the facial nerve's frontal branch and temporalis muscle.
• It provides a viable method for managing associated cerebrospinal fluid leaks.