Unusual Migration of Bullet from the Right Scalp to Left Pyriform Fossa

Spontaneous migration of a retained bullet is rare. Foreign bodies like bullets will be found at the distant site from the region of wound of entry in case they migrate. We report a case of a 17-year-old female with spontaneous migration of bullet from right temporo- parietal scalp to the posterior wall of left pyriform fossa. Twelve years back she had received a gunshot in right temporal region, no exploration was done to remove the bullet. She started complaining of discomfort in the upper neck of two months duration. Rigid laryngoscopy revealed smooth bulge with thinning of overlying mucosa. Radiographs of the neck showed bullet along the posterior pharyngeal wall in the region of the pyriform fossa. CT scan of the head and neck region was done to exclude the presence of any other foreign bodies. Microlaryngoscopy suspension of the larynx was done and CO2 laser was used to incise the mucosa over the bullet and it was retrieved with the help of long artery forceps. Our case illustrates that bullets may take an unexpected course from the site of entry, probably by migration. Trans oral CO2 laser microsurgery is the recommended approach for removal of such foreign bodies.