Gunshot wound to face exits through neck: long term effects, medical jargon, avoiding paralysis?

[braver_creature]

I am writing a fic where one of the characters was shot in the face in-canon, but survived.  The entry wound was towards the base of the left cheekbone, and as far as anyone can tell it crossed left-to-right at a diagonal and exited through the back of the neck, somewhere between the Axis and C3 vertebra of the cervical spine.

Comments

[rubyelf]

Assuming that one does not bleed to death from the bullet hitting any of the major blood vessels in that area, it is totally possible to survive an injury that grazes or even shatters a vertebra in the neck without any paralysis or nerve damage... assuming the injury was quickly stabilized and the person not allowed to move their head or neck until the fracture could be repaired. Surgical repair of fractured vertebrae can involve using the patient's own bone or a metal frame and in a severe fracture will usually involve fusing several vertebrae to make sure the area is stable. The vertebrae are designed to protect the spinal cord, and assuming that bone fragments don't penetrate the spinal cord or that the person does not move around and cause the spinal cord to be damaged, fractured vertebral bones do not necessarily lead to paralysis. Treatment would probably involve complete immobilization with a screw-on halo assuming the break was severe.

In the link you posted it's difficult to see where the exit wound actually is, although it does appear to be low. There are nerves that run through that area outside the spinal cord, but most of the cranial nerves that control facial function are contained within the skull... if those were damaged there might be some drooping or difficulty moving part of the face, but they might not be. Most people who fracture vertebrae do not end up with any form of paralysis, although a high neck fracture is certainly the most dangerous. Assuming the bullet didn't drive bone fragments into the spinal cord and assuming the neck was stabilized before any more damage could occur, it's reasonable to think the injury could be stabilized with surgery and then with immobilization until it had healed. Even partial spinal cord injury doesn't necessarily lead to paralysis... the spinal cord can swell or be compressed by a blood clot and can recover. It's only if nerves in the spinal cord are severed that you end up with paralysis, and the vertebrae are designed to take a lot of damage before that happens. They are fairly sturdy bones in a healthy adult.

(Also, if the bullet went through an inch of glass and still had the velocity to enter AND exit the person, it seems likely that it didn't meet much resistance inside the body... the facial bones are fairly thin, and the bullet would have had to exit the skull at some point for the exit wound to be in the neck, so it's plausible that after the glass, the facial bones, and the skull, the bullet didn't have much energy left to shatter a vertebra and just nicked it, which is entirely survivable without serious consequences. A bullet penetrating the base of your skull, on the other hand... but you already said the character survives the injury, so we'll have to assume that the bullet managed not to damage any part of the brain stem on its way down and out)

[braver_creature]

Thank you so much! This is really helpful.

I knew about the brain stem functions, which is why I was cagey about it passing through the skull at that angle.

But I think however you slice it, there's going to be some hand-waving of major injuries in the show itself, and obviously I'm not writing anything that's going to be too heavily scrutinized for accuracy. I just didn't want to pluck specifics out of the air and then be completely absurd with them.

[rubyelf]

You are very welcome. If it matters, the rehab time for a partial spinal cord injury (i.e. due to bruising or swelling) would probably take several months. Treatment of the initial injury would be mainly to deal with bleeding and with the brain and spinal cord swelling in response to the trauma. If you want to get really specific you can look up brain swelling and how it is treated, but you probably don't want to get that specific. If the spinal cord was traumatized but not actually severed, the person might have loss of sensation and motor control but would probably be able to get most of that back through rehab, although it's a slow process. Like I said, I'd be mostly concerned with how a bullet made it out the lower part of the back of his skull without blowing out his brain stem, but it's certainly possible and I imagine you can get around it. Bullet trajectory inside the skull is an iffy thing especially if the bullet has lost some velocity.