Fig. 13

a Axial non-contrast CT face image on bone-window setting of a 51-year-old man with self-inflicted shotgun injury to the face. The high mortality of self-inflicted shotgun injuries to the face relates to the high tissue-destructive energy of a shotgun fired at close range to the target (compared with long range) as well as the “billiard-effect” created by the shotgun pellets. In this case, the marked avulsion of the facial soft tissues is evident as well as the marked bone disruption and fragmentation of the facial and mandibular skeleton. b Axial non-contrast CT image through the brain on bone-window settings of the same patient as in a. An in-driven canine tooth and attached alveolar bone fragment (black arrow) has penetrated the left frontal lobe, in addition to some of the shotgun pellets. The in-driven fragments of facial skeleton in orbito-facial projectile penetrating injury may become significant secondary damaging projectiles, particularly to the brain