Surgical Removal of Penetrant Firearm Projectile Through Auditory Canal in Temporomandibular Joint Region: Case Report

Gunshot wounds (GSW) are frequent in civilian environments and are usually caused by low-speed guns, such as riffles. Traumas in the temporomandibular joint region (TMJ) are generally related to a high amount of kinetic energy. It can cause damage to anatomical structures such as bone, vessels, or the articular disk, resulting in complications like edema, hemorrhage, limited mouth opening, or ankylosis. Here, we report a case of a 51-year-old male, referred to as a GSW victim in the face through the auditory canal, associated with TMJ lesion and bone fragmentation of the right condyle. Patient was subjected to angiotomography for adequate surgical planning and to decrease surgical risks. Surgery was performed under general anesthesia and access through the preauricular region to remove a single 9.12-mm-diameter projectile and a condyle fragment with the intraoperative help of an image intensifier (fluoroscopy or C-arm). The patient presented a satisfying postoperative period, with reestablished mandibular function, dental occlusion stability, and no joint pain or mandibular deviation during mouth opening.