Endoscopic pediatric endonasal retrieval of transorbital projectile: An illustrative multimedia report

Air guns, particularly BB (ball-bearing or bullet ball) guns, have gained significant power and velocity over the last few decades. More than 145,000 pediatric patients suffered injuries attributed to air guns in the United States between 2001 and 2011, and approximately 22,000 pediatric emergency department visits are attributed to air gun-related injuries annually (Hyak et al., 2020 [1]). This study aims to describe an effective surgical technique in addressing maxillofacial injuries caused by BB gun projectiles in the pediatric population. We present a detailed surgical approach for endoscopic endonasal retrieval of a transorbital projectile in a 13-year-old male who sustained a maxillofacial BB gun injury, with the goal of restoring sinonasal function in a minimally invasive fashion.

CHORIORETINITIS SCLOPETARIA AND ORBITAL EMPHYSEMA CAUSED BY A HIGH-VELOCITY LIQUID MISSILE

PURPOSE

To highlight a case of chorioretinitis sclopetaria, with concomitant macular hole formation and orbital emphysema, caused by a commercial-grade pressure washer.

METHODS

This is a retrospective case report.

RESULTS

A 19-year-old man presented to the emergency department with a left eye injury, incurred after being sprayed with a commercial-grade pressure washer. He endorsed ipsilateral blurred vision, pain, and linear floaters. Left eye visual acuity was 20/40. Dilated fundus examination showed inferior vitreous hemorrhage, retinal whitening, and preretinal, intraretinal, and subretinal hemorrhages, consistent with chorioretinitis sclopetaria. Optical coherence tomography revealed a full-thickness macular hole. Computed tomography scan of the orbits showed subcutaneous and postseptal orbital emphysema. Two months after injury, vitreous and retinal hemorrhages and macular hole resolved. Five months after injury, visual acuity improved to 20/20.

CONCLUSION

Chorioretinitis sclopetaria is defined as a full-thickness chorioretinal disruption resulting from a high-velocity projectile passing adjacent to or into the orbit without penetrating the globe. Chorioretinal deformation and ocular comorbidities are influenced by the velocity of the missile and its spatial relationship to the orbit. Although this pattern of injury is typically associated with indirect trauma to the globe by a BB or a bullet, this is the first report of chorioretinitis sclopetaria precipitated by a high-velocity liquid missile.

Wandering intravascular air gun BB pellet

Approximately 13,500 children each year are treated for non-powder gun injuries of which approximately one-quarter of these injuries are puncture wounds. Although rare, vascular migration of the bullet or pellet (otherwise known as the “wandering bullet”) may result in downstream organ damage secondary to vascular or venous occlusion, most commonly travelling anterograde and lodging within the lung venous system. Interestingly, we present a case of a 12-year-old female who was shot in the neck with a compressed-air gun loaded with ball-bearing pellets. Eventual retrograde vascular migration of the ball-bearing pellet from the right internal jugular vein to the hepatic vein caused hepatic venous occlusion and congestion. It is important for radiologists to remember the possibility of retrograde travel of bullets and pellets, and radiographs should be scrutinized for foreign bodies present in areas other than the region of injury. Bullet retrieval is determined by clinical evaluation and necessity, and if indicated, endovascular, percutaneous retrieval, or surgical exploration may be considered.

Air rifles are more than toys: BB gun-related traumatic brain injury

Gunshot wounds are traumatic events that emergency departments around the country treat on a daily basis. An increasing number of these wounds are being caused by air rifles that shoot ball bearings (ie, BB guns) and, although uncommon, the results can be fatal. The general public and most practitioners may not realize the damage these "toys" can inflict. This article highlights an unfortunate event involving a BB gun accidentally discharged at close range and the consequences. Data from recent and older studies are discussed regarding the firepower of these guns and their potential for injury.