Complex Retained Ballistic Foreign Bodies of the Nasopharynx and Ethmoid Sinus: A Two-Case Series and Review

Abstract

Background: Retained ballistic foreign bodies in anatomically intricate regions such as the nasopharynx or paranasal sinuses are exceptionally rare and pose diagnostic and therapeutic challenges.
Cases: We present two cases in 49‑year‑old males: Case 1 involved a bullet lodged in the posterior nasopharyngeal wall with multiple tooth fragments embedded in the tongue following intraoral gunshot trauma; Case 2 featured a metallic fragment retained in the left posterior ethmoid sinus after a self‑inflicted nasal gunshot wound.
Management and Outcome: Both patients underwent emergency surgical intervention—open retrieval and tracheostomy for Case 1, endoscopic sinus surgery with septoplasty for Case 2—and recovered uneventfully.
Conclusion: These cases underscore the critical role of high‑resolution computed tomography, multidisciplinary planning, and tailored surgical approaches in successfully managing rare upper aerodigestive ballistic injuries.