Computerized tomography in craniocerebral, maxillofacial, cervical, and spinal gunshot wounds. Part II--Clinical contribution and medico- legal aspects.

To assess the diagnostic and medicolegal contribution of Computed Tomography (CT) in patients with craniocerebral, maxillofacial, neck and spine gunshot wounds, we submitted to CT 106 patients with gunshot wounds examined over a 7-year period (February, 1988 to December, 1994). Twenty-four of them had craniocerebral injuries (23%), 9 maxillofacial (8%), 8 neck (8%) and 10 vertebral (9%) injuries. Emergency CT demonstrated the mechanism of the injury, the bullet path and site, the site of bone and/or metallic fragments, and damage extent. In all perforating cranioencephalic injuries (n = 7) intracerebral or extrathecal bone fragments were demonstrated adjacent to the bullet entrance and exit holes, respectively. In injury monitoring, CT showed injury evolution, retained fragments and complications, thus enabling damage extent assessment. High Resolution Computed Tomography (HRCT) was useful in locating minute orbitary retrobulbar and intraspinal fragments. Magnetic Resonance (MR) Imaging in postoperative patients proved a valuable tool to assess the extent of spinal cord damage. To conclude, CT is a useful technique to examine the patients with gunshot wounds, which helps plan adequate treatment and solve complex medicolegal problems.