This previously healthy patient was admitted as an emergency case with a wound in the right side of his face as a result of a grenade explosion. The patient was quiet, responsive and co-operative. Clinical examination revealed preserved eye movements, pupils were equal and reflexes were intact. The skin colour was normal and mucous membranes moist. External oral examination revealed right upper lip paraesthesia, significant hemi-facial oedema (image A) and an intraoral to extraoral communicating injury of 2cm diameter with rough edges, but no active bleeding. Intraoral findings were generalised bruising, complete vertical fractures of the upper right canine, 1rst premolar, 2nd premolar and 1st molar (image B). Radiographic studies confirmed these fractures as well as revealing a fracture of the right upper alveolar ridge, and fragments of the explosive device at the level of the anterior wall of the maxillary sinus. The grenade splinters and tooth fragments that were removed from the injured area are shown in images C and D respectively.
