Self-inflicted submental and transoral gunshot wounds that produce nonfatal brain injuries: management and prognosis.

OBJECT: Penetrating brain injuries caused by self-inflicted gunshot wounds are very often fatal and survivors suffer serious disabilities. Recognition of a possibly more favorable prognosis for a specific type of injury, the submental or transoral handgun or low-energy rifle wound, prompted the authors to review their experience with patients who had attempted suicide in this manner.

METHODS: The records of 11 consecutive patients seen over a 10-year period (1992-2001) were retrospectively reviewed. Handguns were used by eight patients and .22 caliber rifles by the others. The patients presented with predominantly unilateral frontal brain injuries that required urgent attention. One elderly patient who had made an advance directive concerning care died. All other patients underwent craniotomy and repair of associated ophthalmological and maxillofacial injuries. Follow-up review ranged from 9 months to 3 years, during which time there were no repeated suicide attempts. All but one patient expressed satisfaction with their appearance and returned to a self-sufficient lifestyle.

CONCLUSIONS: Self-inflicted submental and transoral handgun and low-energy rifle wounds may produce serious but survivable brain injuries if the path of the bullet is limited to the frontal area. Early aggressive management of brain, dural, and craniomaxillofacial injuries should return the patient to a highly functional neurological status and restore an acceptable outward appearance. Outcomes, therefore, appear to be much better for these patients than for most patients with a penetrating brain injury due to a self-inflicted gunshot wound.