I. Hecimovic et al., Transoral missile removal from the anterior C1 region following transpharyngeal missile wound, ARCH ORTHOP, 119(5-6), 1999, pp. 340-343
We present a successful treatment result in a rare case of low velocity mis
sile transpharyngeal wound to the upper cervical area in a 33-year-old man.
There are very few reports concerning related cases, with some disagreemen
t regarding their treatment. The retained missile was successfully removed
from the anterior region of the C1 vertebra through a transoral-transpharyn
geal approach using the explosive transpharyngeal wound sustained. Neurolog
ical status and spine stability were not affected due to the missile's low
velocity. The early soft-tissue debridement, missile removal, pharyngeal cl
osure without wound drainage and broad-spectrum antibiotic coverage resulte
d in an uneventful postoperative course and good long-term outcome. Early s
urgery is important to prevent complications in such cases. However, the pr
ophylactic tracheostomy, wound drainage and applying of a nasogastric tube
could be left to the surgeon's judgment based on the individual patient's r
espiratory status, intraoperative findings and wound contamination/coloniza
tion.