Gunshot injuries are on rise in both developed and developing countries, the reason for this may be increased access to firearms. Gunshot injuries to the neck and maxillofacial region are associated with high morbidity and mortality (11%) due to complex anatomy and various vital structures in this region. Gunshot wounds cause injury by three mechanisms- direct tissue injury, temporary cavitations and transmission of short waves.

It is indeed a rare finding that a bullet’s trajectory passes through the neck region and does not damage vital structures .We present such a case of gunshot injury to the neck. Causes of such cases may be homicidal, suicidal and in rare cases, accidental. The high density of vital structures include trachea ,oesophagus, carotid and vertebral arteries, cervical spine and spinal cord, phrenic nerve and brachial plexus- are all vulnerable with injury with neck trauma. Any delay in diagnosis and treatment can lead to devastating consequences

A one and half year old child reported to casualty of Goa Medical college, approximately 4 hours after sustaining a single accidental gunshot wound in the neck, anterior to left sternocleidomastoid muscle measuring 0.5 by 0.5 cm. No gun powder around the entry wound. No exit wound seen. His chief complaint was neck pain. No neurological deficit was noted on examination. He was conscious. Sensory examination was intact for pin prick and light touch throughout and vital signs were within normal limits. Both carotid pulses palpable and there were no carotid bruits. X ray showed bullet in the left mediastinum at the level D1 D2 vertebra, tip of the bullet seen directed posteroinferiorly. No haemopneumothorax.

Surgical exploration of left anterior cervical region and thoracotomy was performed under general anaesthesia. The bullet was identified and removed off thoracic cavity and the path of the projectile excised. Intraoperative and postoperative period was uneventful.

Conclusion
The four main steps in the management of such patients- securing an airway, controlling haemorrhage, identifying other injuries, and repair of residual traumatic deformities. Our report illustrates that knowledge of the path of the projectile and its termination and thorough clinical evaluation of the patient are critical factors for assessment and management of patient with gunshot injury