Firearm injury to the face with bullet lodged in the nose

In all firearm injuries,treatment should be individualized as there is no set protocol for head and neck firearm injuries. five main steps of management should be observed,securing airway,controlling hemorrhage,identifying other injuries,removal of f.b when necessary and repair of the facial injury. a patient came to ent outdoor with complaint of firearm injury on face with nasal pain and obstruction. entry wound observed on right zygomatic arch 1.5 cm below right lateral canthus which was almost healed. x-ray pns and nasopharynx lateral view showed a radio opaque foreign body in right nasal cavity at level of middle meatus. we planned examination under general anesthesia and proceed. foreign body was approached intranasaly and encountered at level of middle meatus and removed. f.b was actually a bullet sized 1.4 ∗ 1 cm. © 2014 pakistan journal of medical and health sciences. all rights reserved.