BULLET and shrapnel wounds of the face frequently penetrate the osseous walls of the maxillary antrum or the floor of the nasal fossae. Ranging downward in their course, these foreign bodies pass through the roof of the mouth, creating large and frequently multiple defects in the hard palate. These deficiencies may represent oronasal or oroantral fistulas.
This type of injury is commoner than is generally supposed, because the face is the one part of the head that is unprotected by the helmet. A great many wounds of the face are due to sniper fire from an elevation such as a tree or a hill, which gives the bullet its characteristic downward course. The thick walls of the malar and the maxillary bone afford some measure of protection to the tongue and other contents of the oral cavity, as in most instances the velocity of the projectile is spent somewhat in
WIBLE LE, HOWARD JC. TRAUMATIC PALATAL FISTULA. Arch Otolaryngol. 1946;44(2):159–165. doi:10.1001/archotol.1946.00680060176004
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