Management of Penetrating War Injuries: Bullet/Shell Fragments in the Sphenoid Sinuses

PurposePenetrating sphenoid sinus injuries in both war and civilian practice are rare. A review of the literature shows no reports of shell fragments or bullets in this region; hence, the rarity of the cases prompted this report.Materials and MethodsA variety of surgical approaches—transethmoidal, transnasal trans-septal, sublabial transnasal, and endoscopic techniques—and the feasibility, efficacy, and safety of these techniques used in the delivery and management of missiles lodged in the sphenoid sinus under conditions of war are described.ResultsFour shell fragments and 2 bullets were removed without increasing morbidity and with avoidance of unnecessary trauma to the area affected by the missile.ConclusionsIn this series of patients with war missile injuries settled in the sphenoid sinus/base of the skull undergoing surgical treatment, there were no major intraoperative or postoperative complications. Differentiation in the approaches to this anatomic region is necessary based on whether there is a tumor or penetrating war injury.