A young pregnant woman showed up at the hospital at Bagram Air Force Base with a ricochet bullet lodged in her cheek. It had been bandaged but was causing blurry vision, so she had come for help.

"That was the only tip-off we had that something else was going on," Dr. Travis Newberry, a head and neck surgeon and U.S. Air Force major who is now based at the San Antonio Military Medical Center in Texas, told NPR.

"Anteroposterior and lateral scout (preliminary) images were obtained and revealed an approximately 1.2 × 5–cm metallic foreign body that appeared to have penetrated upward, through the maxillary sinus, terminating approximately at the floor of the anterior skull base. Computed tomography was performed, which confirmed penetration through the cribriform plate," Newberry and his colleagues reported in the Journal of Neurosurgery.
This rattled the attending physicians. "I wasn't expecting to see much at all," Newberry recalled, noting, "it was extending from just above her teeth through the base of the skull, touching the brain."

It had to come out, but "it was awfully large and it wasn't a fragmented bullet, which is what we usually see."

They could see the bullet-shaped object and a rim around it, but couldn't tell if it was packed with explosives, or not, although it appeared to be of uniform density, making the odds of it being explosive relatively low.

Nonetheless the surgical team suited up and prepared the OR for dangerous unexploded ordnance surgery, just in case.

They wore protective goggles, helmets and flak jackets as well as scrubs. The patient was pre-oxygenated and given general anesthesia, and as a precaution, "a low (20 percent – 30 percent) fraction of inspired oxygen was used, given the potentially flammable risk. While monopolar electrocautery was avoided during the procedure, the patient was electrically grounded to minimize accumulation of static electricity, which theoretically could trigger activation of an ordnance."

Luckily, when removed, the ordnance turned out to be a non-explosive bullet. But that has not and will not always be the case. after its removal the team performed facial reconstruction of the young woman, who recovered well from her ordeal.

Fortunately the military has guidelines, from 2012, for this sort of situation, worth noting by health care providers even in non-military settings in this era of increasing threats of military-style terrorist attacks.

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