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

[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.

Gunshot wound to face

[anonymous]

You might have a look at a well-documented similar injury -- that of Phineas Gage, who took an iron tamping rod through the face:
http://www.smithsonianmag.com/history/phineas-gage-neurosciences-most-famous-patient-11390067/?no-ist

This article is actually even more cool, because it has computer generated images of how the rod went through the guy's head:
http://www.slate.com/articles/health_and_science/science/2014/05/phineas_gage_neuroscience_case_true_story_of_famous_frontal_lobe_patient.html

Clearly it is possible to survive an injury like that, but you have to be lucky with a capital L.

Re: Gunshot wound to face

[rubyelf]

The tamping rod actually went directly up through his frontal lobe, though, which means it was a completely different trajectory... and you can live without a good part of your frontal lobes. That's what a lobotomy does. The injury this question is asking about goes through or under the cheekbones and appears to exit the back of the skull or the neck, which puts it dangerously close to the brain stem, which you cannot live without.