Air-gun pellet injuries to the head and neck

Air-gun pellet injuries (AgPI) of the central nervous system (CNS) are rare but catastrophic events. They occur mostly in children and young adults. The entrance is usually either through the orbit or through the neck and the entry wound is so small that it may be disregarded on physical examination in the emergency room. Early recognition and correct management of the possible complications of AgPIs is important and may prevent a poor outcome. METHODS We intend to present our experience with 16 cases of AgPIs of the head and neck referred to the department of neurosurgery during the last 15 years. The characteristic findings on physical examination of the cases and the imaging studies performed are described. Special management undertaken for the rare complications are mentioned and a short literature review is performed on each entity. RESULTS All our cases happened in the first and second decades of life and only in boys playing with toy guns. There were 12 head and face and four neck wounds. Damaged globe that had to be exenterated was the earliest complication, handled by ophthalmologists (four cases). Cerebrospinal fluid (CSF) leakage, meningitis, brain abscess formation, development of traumatic aneurysm (TA), carotid-cavernous sinus fistula (CCF), wandering intracerebral and intraventricular pellet, and splitting of the pellet after striking hard bone were the complications noted. In addition to plain X-ray films, computed tomography (CT) scanning and angiography were diagnostic procedures of choice. CONCLUSIONS The present series of patients is the largest collection of AgPIs to the head and neck reported in the literature in which nearly all the possible complications of such injuries have been reviewed. Early recognition and awareness of the possible cumbersome complications of such a minor penetrating wound can prevent major catastrophies in this young group of victims.