Treatment for Rowdy After Accidental Gunshot Wound to the Jaw

External dental photograph showing the small entrance wound (white arrow).

Rowdy is a 2 year old boxer who enjoys life roaming on a few acres outside town. One night, he sustained an accidental close range gunshot wound to the jaw; the shell entered through the cheek of the lower left jaw, passed through the mandible and along the tongue and exited the mouth and lodged under the skin of the right front shoulder.

Rowdy’s owners transported him to the ER for immediate care and to stabilize him prior to evaluation at Southern California Veterinary Dental Specialties and Oral Surgery.

Dr Brook Niemiec evaluated Rowdyand found that externally he was normal and oral exam only showed a small hole on the outside of his gum.

External dental photograph showing the small entrance wound (white arrow).

External dental photograph showing the small entrance wound (white arrow).

A thorough oral exam performed under anesthesia showed:

  • A small enterance and large exit wound throgh the mandible (Figure 2) , creating a “through and through” hole in the left mandible. (Figure 3)
  • A large ventral tongue laceration with pieces of the mandible and shell (“bullet”) fragments embedded in it. (Figures 4 & 5)

Dental radiographs performed under anesthesia showed:

Tooth roots (The back root of the large molar and the front root of the small molar were shattered broken below the gumline.  Luckily though, the bottom and top of the jaw were still canal intact, so the jaw itself was not actually completely broken.  A large number of bullet and bone fragments were seen in the damaged area.

Pre-op dental radiograph revealing the large defect (red circle) the damaged roots (blue arrows), and the bone shards (white arrows). The bright white dots are lead “shrapnel” left behind by the bullet.

Dr. Niemiec first removed the bone and bullet fragments from the tongue. Then he cleaned and sutured (stitched) it together.

Following bone and tooth root removal from the tongue, the defect was sutured.

Next, he accessed the wound in the jaw (figures 9 & 10) carefully cleaned the shards of bone, tooth, and bullet from the jaw (Figure 11) and closed the soft tissues (gums). He also extracted the second molar. (Figure 12)

Finally, he performed a root canal on the front root of the large molar and did a fancy “surgical” root canal filling of the back root. (Figure 13). The reason for this unique and inventive approach was that if that part of the tooth was removed, the jaw may have broken.

Post-operative dental radiograph showing the root canal treatments and cleaned debris. Note that complete removal of the lead is impossible without further damage to the bone and In general does not pose a health problem.

His recovery was uneventful and he was back to normal the next day.  We just saw him at 2 week recheck and he is doing great!  One amazing thing is that he never stopped eating!