Gunshot injuries : how they are inflicted : their complications and treatment . temple 2 1/2 inches above and1 inch posterior to the right passed through the superior maxilladownward and backward, cut2 throughthe posterior portion of the soft palateand entered the neck. Here it becamedeflected, probably by the thyroidbone, and entered the thyroid cartilage,thoroughly comminuting it, cutting into the esophagus wall where,being spent, it dropped into the stomach. The patient states thathe subsequently passed the bullet per rectum. There was profusehemorrhage from the mouth and nose. H
Gunshot injuries : how they are inflicted : their complications and treatment . temple 2 1/2 inches above and1 inch posterior to the right passed through the superior maxilladownward and backward, cut2 throughthe posterior portion of the soft palateand entered the neck. Here it becamedeflected, probably by the thyroidbone, and entered the thyroid cartilage,thoroughly comminuting it, cutting into the esophagus wall where,being spent, it dropped into the stomach. The patient states thathe subsequently passed the bullet per rectum. There was profusehemorrhage from the mouth and nose. He experienced difficulty inbreathing and swallowing. The difficulty in breathing became so ag-gravated that it was necessary to perform tracheotomy August is still wearing the tracheotomy tube. There is complete obstruc-tion in the larynx. His voice is heard in a whisper when the finger is 1 Walter von Oettingen, Studien auf dem Gebiete des Kriegs-Sanitats-Wesensim Russisch-Japanischen Kriege, 1904r-1905. Berlin, 1907. 2 Dr. Emil Meyer, Meeting A. M. Association, Fig. 117.—Photograph of J. H. Mose,March 4, 1911, at which time he wasstill wearing tracheotomy tube. GUNSHOT WOUNDS OF THE HEAD, FACE AND NECK 213 pressed over the tracheotomy tube. The laryngoscopic appearancesare described in Dr. Meyers article. Treatment.—Wounds of the larynx and trachea need promptattention on surgical lines. Wounds of the front segment of thetrachea without undue loss of substance are best treated by suturingif the respiratory efforts will permit. Tracheotomy is in order inall cases where dyspnea is present. Bleeding from injured vesselsshould be arrested by ligation and when the esophagus is wounded,if there is much difficulty in swallowing with extravasation of food inthe tissues of the neck, feeding should be done through an esophagealtube introduced into the stomach through the mouth, or a smallflexible catheter may be passed through the nose into the the woun
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