Shrapnel Dislodges From Man's Jaw After 65 Years

May 29, 2009 — -- At 5 a.m. on May 4th, 87-year-old Alfred Mann woke up with a strange object in his mouth. Reaching for his handkerchief, he spat out a half-inch metal shard -- shrapnel from a battle injury he sustained 65 years ago.

"It was a surprise," said Mann of Sheldon, Birmingham, in the U.K.

Mann, who served as a nurse with the Royal Army Medical Corps during World War II, was injured by an exploding land mine in Monte Cassino, Italy, at age 19. The blast left him with injuries to his face, shoulder and leg, as well as hearing loss.

Mann was treated at a hospital in Naples, but no one discovered the piece of shrapnel lodged somewhere in his jaw. Even after he healed, Mann was limited to eating soft foods and he had difficulty speaking. During the years, doctors attributed the pain and bleeding in his mouth to ulcers, advising him to see dentists.

Although Mann suffered significant medical problems, it is not uncommon for doctors or patients to overlook a piece of metal lodged somewhere in the body -- accidentally or on purpose.

"If [the shrapnel] is not near anything sensitive, they may not even notice it," said Dr. Gerard Rebagliati, assistant professor of Emergency Medicine at Oregon Health and Science University in Portland.

The greatest dangers with shrapnel injuries are if they are lodged in or near vital organs or if they migrate to areas where they are not supposed to be and cause damage.

But if a piece of shrapnel has little potential for damage, doctors will often leave the fragment in the body rather than perform risky surgery, which will further damage body tissues, to remove it, even if they have a general idea where the shrapnel might be.

"The reason foreign bodies get left behind is because with war injuries, even more than with civilian-type gunshot wounds, there can be literally thousands of fragments deep within the muscles," said Dr. Jay Doucet, director of the Surgical Intensive Care Unit at the University of California, San Diego. "If you do so much cutting and sectioning, you end up causing worse problems then the fragments themselves cause."