Gunshot wound to the mandible with secondary neck injuries

Four consecutive patients were initially seen with witnessed, low-velocity gunshot wounds to the mandible with deflection of the bullet into the neck, causing a life-threatening situation. The mechanics of injury were similar in all four patients who were shot at close range with a moderately heavy caliber handgun and sustained comminuted fractures from the parasymphyseal area to the ascending ramus of the jaw. Severe vascular injuries were seen in three cases and lacerations of the pharynx and cervical esophagus in one. Aggressive management of these injuries is recommended, with neck exploration after endoscopy playing a major role. Management of the mandibular fracture at the time of the initial surgery is favored. However, if roentgenograms are unavailable, reduction and fixation may need to be deferred.