Contemporary management of penetrating neck trauma

A combination of the bullet's velocity, as well as the kinetic energy transferred to structures upon entry, causes a devastating shock-wave (or "pulsatile") effect to the surrounding tissues, creating a zone of injury up to 30 times the size of the missile. [...] tissue not immediately adjacent to the bullet is at risk for injury or perforation, as direct penetration is not required to cause injury with this type of ballistic.\n Water irrigation through the mouth and oropharynx and into the esophagus with a bulb syringe can both identify site of the leak as well as confirm watertight closure.