one about 10 mm in diameter, seen two months after surgery. There was no nasal whistling or bleeding and, after discussion with the patient, it was decided to leave the perforations untreated unless symptoms developed.
In the presence of missile-related trauma of the face, the principles of careful inspection for extent of injury, adequate debridement of devitalized tissue, and radiographic examination for foreign body have generally been accepted. Delayed or primary closure is carried out as indicated by the facilities available, the type of injury, and the presence or risk of infection. Antibiotics may be used prophylactically. 1
In this case, the emergency physician delayed a specialty referral, and the consulting service itself did not discover the foreign body immediately. With the presence of broken skin and the history of exposure to high velocity missiles, a radiographic study might have been in order at the initial visit. Entrance wounds can be surprisingly small. Here, the naris offered a nearly adequate entrance port, with the alar tear and the septaI mucosal disruption the only other clues that an object had penetrated and lodged.
Because prolonged retention of a foreign body offers no advantage to the patient, and may be dis: astrous, a high index of suspicion is in order in a patient with this type of history. Radiographic examination would be appropriate in all head and neck patients (and other patients) with broken skin who have been exposed to high velocity missiles.