Several years back, I took this radiograph on a patient of mine, and I shared it with James Yeager and a few friends in the training community.  As luck would have it, the picture and my short narrative, somehow came across Clint Smith’s desk.  He shared it through his channels, and before long, this image was all over the interwebs.

Maybe you saw it back then?  If you didn’t, let me refresh your memory!  This patient came to me, at my dental office, for two reasons (it bears mention at this point that I’m not your regular dentist that does whitening and teaches you how to brush…I mostly address abscesses, rotten teeth, and dental trauma in the Hispanic population of Middle Tennessee) FIRST:  he couldn’t open his mouth, and SECOND:  he was concerned that whenever he drank water, it came out his nose.  Hmm…well, neither of these things is normal, so as is the custom in my office, the patient’s blood pressure and pulse are taken, their medical history is reviewed, and any necessary radiographs are made.

Imagine my surprise when I inquired about the patient’s black eye and small abrasion/laceration beneath his right eye.  (In Spanish). “Oh, I got shot.”

“You WHAT?”  I exclaimed.

“I got shot in the face.  I was minding my own business when a narco hit me with his pistol then shot me.  I passed out.  I woke up, and decided I needed to get out of there before the narcos realized I was alive.  So I got on a few buses and came here, to Nashville.”

After the X-ray, and my clinical exam, it was easy to see what happened.  The bullet (a Federal 230 grain Hydrashok) entered the patient’s midface, at a downward angle, and traveled through his maxillary sinus, exiting through the maxillary tuberosity, shattering the first and second molars, and entering his mouth (depositing pieces of jacket along the way), then spiraled through his mouth, into the right mandible, and then fragmented, leaving a large hunk of the jacket entangled just above the substance of his right parotid gland, THEN the remaining core of the projectile went left, further tumbling through his mouth and buccal mucosa, coming to rest in front of the tissue of his left auditory meatus.

So his chief complaints of not being able to open his mouth made sense, since the bullet had effectively, “door chocked,” his jaw from fully opening, mostly due to soft tissue swelling as well as the mechanical presence of the bullet’s core.  Also, he had what we call an, “oral antral  communication,” meaning the wall between his sinuses in his nose and the space inside of his mouth, were one.  Hence, the water when he drinks, coming out his nose.

When this information got out, people said silly things like, “.45…so puny it’ll send the badguys to the dentist!”  And other dumb nonsense.  But think about this from a defensive gun use perspective (even though THE facts of this case may have been otherwise) where the bullet actually did it’s job!  It was delivered to a vital area, did a considerable amount of internal damage, fully deposited all of its energy in the target, and made the recipient lose consciousness, instantly, at least for a indeterminate amount of time (he estimated five minutes or longer).  From a civilian self defense perspective, if I was forced to use THAT round delivered to that location, I’d consider that effect, a success!  That would give me enough time to run away, call 911, or get to a secure (or more secure area).

Bottom line, handgun projectiles suck at stopping people.  But this one, DID, in this instance.  It stopped them quite effectively, so much so, that they left the damn country!  .45’s aren’t a death ray, but they CAN stop people from doing whatever it was they were doing!

9 thoughts on “.45 ACP to the Midface

  1. You have been busy writing and I found this pretty fascinating. Keep it up.

  2. Wait…isn’t this social media, kind of? Luckily I have friends that have the social media game on point. They can keep up on posting the things they like to read! Thanks for reading.

  3. I found this on social media. Wouldn’t have seen it otherwise. Don’t quit social media, TAKE social media. It belongs in the hands of society, but won’t stay there if people like you give up, others buy it.

  4. He did fine. I removed a few of the jackets fragments that I could see, and I sent him to the OR for removal of the remainder of the projectile. Some of it had to be left in place, since it was so intimately entwined in the parotid gland, it would’ve potentially damaged his facial nerve to remove it. The fistula is an easy(easier) repair using a creative intraoral flap technique.

    Thanks for reading! I’ve quit all social media, and changed my focus of free time when I’m not being a parent or a spouse to physical training, mental training, self defense training, and writing. It’s very liberating.

  5. More from a medical prospective, how did he end up doing. Was there any way or any need to correct the oral antral communication?
    Very nice write up and thought provoking perspective. I’m glad to see you writing again.

  6. While I never worked in an environment like the one you practice in I did serve 30 years as a police officer in various capacities. Two cases involving 1911 5″ 45s used in shootings come to mind! In the first two men were arguing outside a bar when one pulled a Colt 45 Gov’t model with hardball in the chamber and shot the other man under the left eye. The victim collapsed like a box of rock, and died two days later in an ICU. All hostilities ceased moments after the discharge.

    The second case was a Deputy Sheriff who responded to a call in a rural area where a local large man who was mentally deranged was beating on his elderly mother. Upon arrival the Deputy Sheriff, who was alone, proceeded to the house and found the woman bloody and battered. He called for an ambulance and began treating her wounds. He was struck by the large man and knocked to the floor. The large man then began swinging at the Deputy with an axe handle. As the deranged individual brought the axe handle over his head with both hands. The Deputy fired one round of hardball at his head and the bullet and the man’s right arm met approximately 30 inches from the muzzle. The bullet struck the bone in the forearm and shattered. Yup 230 grain jacketed bullet shattered. The bad guy surrendered and went to the hospital and then to jail. Interesting!

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