Download PDF
J Neurol Surg B Skull Base
DOI: 10.1055/a-2052-8668
Original Article

Orbitocranial Penetration of Ball Bearing Gun Trauma: A Prospective Human Cadaveric Study

Angela J. Oh
1   Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, United States
,
Kelsey A. Roelofs
1   Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, United States
,
Justin N. Karlin
1   Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, United States
,
Daniel B. Rootman
1   Division of Orbital and Ophthalmic Plastic Surgery, Jules Stein Eye Institute, University of California, Los Angeles, California, United States
› Author Affiliations Funding This work is supported by an Unrestricted Grant from Research to Prevent Blindness, Inc., to the Department of Ophthalmology at UCLA.
› Further Information
    Permissions and Reprints

Abstract

Objective We completed a prospective human cadaveric study to determine the ability of a ball bearing (BB) pellet to penetrate the orbit and/or surrounding structures.

Methods A single trained sergeant officer discharged an alloy steel air rifle to eight cadaver orbits from four adult human cadaver heads. Five BB pellets each were aimed at three locations (caruncle, upper eyelid, or lower eyelid) at 10 cm and 1 m, and then less specifically, at the orbital region for 3- and 5-m distances. Computed tomography (CT) of the cadaver heads was performed. Final locations of BB pellets are divided into three categories: intracranial, surrounding orbital structures including the pterygopalatine fossa and infratemporal fossa, and orbit.

Results Of 40 BB pellets, 37 penetrated soft tissue and were visualized on CT: 19 (51%) rested in the intracranial space, 17 (46%) in surrounding orbital structures, and 1 (3%) within the orbit. The deepest position of a pellet was in the parietal lobe, and most superficial location anterior to the frontal bone. Pellets discharged from 1 m were more likely to rest in the intracranial space compared with those from 10 cm (p < 0.001), 3 m (p = 0.011), and 5 m (p = 0.004). The distance of discharge was associated with final pellet location (p = 0.001).

Conclusion BB guns should be considered dangerous and potentially deadly when aimed at the orbit. Although the thick calvarium can protect the intracranial space from BB penetration, the orbit may be a vulnerable entry point with relatively low resistance, allowing penetration of the intracranial and periorbital spaces.

Keywords

ball bearing - cadaver - trauma - orbit

Note

This work was presented as a poster at the 53rd Annual Fall American Society of Ophthalmic Plastic and Reconstructive Surgery Meeting in 2022 in Chicago, Illinois.




Publication History

Received: 13 November 2022

Accepted: 07 March 2023

Accepted Manuscript online:
13 March 2023

Article published online:
13 April 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Hyak JM, Todd H, Rubalcava D, Vogel AM, Fallon S, Naik-Mathuria B. Barely benign: the dangers of BB and other nonpowder guns. J Pediatr Surg 2020; 55 (08) 1604-1609
    CrossrefPubMedGoogle Scholar
  • 2 Aziz M, Patel S. BB gun-related open globe injuries. Ophthalmol Retina 2018; 2 (10) 1056-1061
    CrossrefPubMedGoogle Scholar
  • 3 Lee R, Fredrick D. Pediatric eye injuries due to nonpowder guns in the United States, 2002-2012. J AAPOS 2015; 19 (02) 163-168.e1
    CrossrefPubMedGoogle Scholar
  • 4 Ahmadabadi MN, Karkhaneh R, Valeshabad AK, Tabatabai A, Jager MJ, Ahmadabadi EN. Clinical presentation and outcome of perforating ocular injuries due to BB guns: a case series. Injury 2011; 42 (05) 492-495
    CrossrefPubMedGoogle Scholar
  • 5 Powley KD, Dahlstrom DB, Atkins VJ, Fackler ML. Velocity necessary for a BB to penetrate the eye: an experimental study using pig eyes. Am J Forensic Med Pathol 2004; 25 (04) 273-275
    CrossrefPubMedGoogle Scholar
  • 6 Darwish A, Lars-Uwe S, Gehl B, Sudhoff H. An unusual foreign body within the pterygopalatine fossa: a case report. Arch Otorhinolaryngol Head Neck Surg 2019; 3 (01) 3
    CrossrefPubMedGoogle Scholar
  • 7 Sunita MMS, Sanjeev MK, Ravi KS, Aarzoo J, Ajai A. Anatomical and clinical characteristics of paediatric and adult eyes. Natl J Clin Anat 2021; 10: 5-9
    CrossrefPubMedGoogle Scholar
  • 8 Kennedy EA, Ng TP, Duma SM. Evaluating eye injury risk of Airsoft pellet guns by parametric risk functions. Biomed Sci Instrum 2006; 42: 7-12
    PubMedGoogle Scholar
  • 9 Thach AB, Ward TP, Hollifield RD. et al. Ocular injuries from paintball pellets. Ophthalmology 1999; 106 (03) 533-537
    CrossrefPubMedGoogle Scholar
  • 10 ASTM. Standard specification for eye protective devices for paintball sports. Document number ASTM-F1776-22 2022
    PubMedGoogle Scholar
  • 11 Varr III WF, Cook RA. Shotgun eye injuries. Ocular risk and eye protection efficacy. Ophthalmology 1992; 99 (06) 867-872
    PubMedGoogle Scholar