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A 25 year old male presented to the Parkland Memorial Hospital Emergency Room with a single gunshot wound to the body of the left mandible. He had been intubated in the field, and was moving all extremities on arrival. Intraoral hemorrhage was controlled by packing his mouth with a roll of Kerlex.
The lateral cervical spine film shows that the fragments had traversed Zone II of the left neck.
As his hemorrhage was controlled by packing, the patient was then taken to angiography. The anterior view of the left common carotid angiogram shows complete disruption of the carotid artery with comminuted mandibular fracture.
The lateral view shows external carotid extravasation and internal carotid thrombosis.
The patient was then taken to the operating room for exploration of his neck through a left anterior sternocleidomastoid incision.
Contusions of the internal and external carotid arteries were noted with a laceration of the external. In the image below, the common carotid has been divided just proximal to the injury, and the contused external and internal carotids are plainly visible as the transected stump of common carotid is rotated cephalad.
Above, the injured area has been excised. The external carotid stump has been ligated, and the internal and common carotid arteries have clamps on them.
A reversed saphenous vein graft was then used to reestablish flow from the common carotid to the internal carotid artery.
The final incision with the mandibular entrance wound. The patient awoke neurologically intact and had an uneventful convalescence prior to being discharged home.
Submitted by: Herb Phelan, Brian Eastridge, Parkland Memorial Hospital, Dallas, Texas