Inside Trauma Center Care: “He Didn’t Mean to Shoot”

You couldn’t call John Macleod lucky, exactly, that day in November 2016. Lucky would have been not being shot in the face at all.

But with that large exception, fortune was smiling on Macleod. How else, after a 410-gauge shotgun shell was fired at close range from a .45-caliber pistol at his face, could he be looking fine and speaking and chewing normally today? Says the 40-year-old electrical lineman from Lowell: “You can’t even tell I got shot.”

What helped was prompt treatment by several clinicians, including Richard Panek, DDS, a surgeon at the Center for Oral Surgery & Dental Implants. This case wasn’t typical. “It was a once-in-a-career injury for an OMFS,” says Dr. Panek.

Though Macleod is fine today, trauma can create complications for future dental treatment. “If a patient with a prior facial trauma presents in your office, we’re happy to explain what procedures the patient had done in the hospital and, via video or in person chat, we’re always ready to consult to make a comprehensive treatment plan,” Says Emily Van Heukelom, DDS.

Such consultations can be important. Roseanna Noordhoek, DDS, explains: “A fracture in a joint can, years later, lead to an increased chance of arthritis, tooth luxations and fractures can have pulpal necrosis that doesn’t become symptomatic till later, some occlusion problems will require orthodontic evaluation and treatment.”

In this post and two others, Drs. Panek, Noordhoek and Van Heukelom share recent trauma center patient stories.

He didn’t mean to shoot

Macleod was shot by a troubled family friend afflicted by a toxic mix of alcohol, drugs and resentment. The friend intended only to wave his pistol and warn Macleod and others off his property. But as he quickly raised the gun it went off. “I know he didn’t mean to shoot me,” says Macleod.

He was airlifted to Spectrum Health Butterworth Hospital in Grand Rapids, a Level I trauma center that draws cases from all over West Michigan. There he was given a tracheostomy to maintain his airway, and a feeding tube was inserted into his stomach.

Piecing the puzzle together

“The bullet entered between the chin and the lip and basically shattered the mandible and the teeth in the area,” says Dr. Panek. “Then it broke into several pieces. One piece went through the roof of his mouth into his nose. Two came off and went into his cheeks. The remainder went through his tongue and stopped right at his spine. Had it gone further it probably would have severed his spine, at the C3 or C4 level, and he’d be paralyzed.” Dr. Panek made a 12-centimenter incision under the jaw and “de-gloved” it, pulling the skin upward. Then he reassembled the jaw using seven titanium plates and 28 titanium screws.

Macleod has his own way of describing the oral surgeon’s achievement. “They handed Dr. Panek a Ziploc bag full of bones and teeth,” he says, “and he put it back together like a jigsaw puzzle.”

A team effort

The doctors who first stabilized the patient made all this other work possible, as both Macleod and Dr. Panek stress. A spinal surgeon removed the bullet fragment near the spine, and a head-and-neck surgeon extracted the one from his nose. But when that surgeon saw the facial trauma left for Dr. Panek, he said: “Looks like you got the worst of it.”

A year later, Dr. Panek removed some of the plates and screws and took additional bullet fragments out when encountered. He also placed implants on which a prosthodontist secured a prosthesis. His minimal scarring is limited to an inconspicuous semicircle under the chin.

For Macleod, gratitude extends into personal admiration: “Dr. Panek is one of the greatest guys I’ve ever met in my life. He deserves an award.”

The oral surgeons at the Center for Oral Surgery & Dental implants “are kind of a bridge between medicine and dentistry,” says Dr. Panek. Having completed a rigorous four-six-year surgical residency beyond dental school, they’re among 13 oral surgeons in West Michigan who take turns on call at the trauma center. Starting at 6 p.m. Monday and round the clock for a full week, the surgeon on call must respond within 20 minutes and if necessary be at the hospital within an hour. Dr. Panek admits that he doesn’t sleep too well during his weeks on call. When he and his wife go out for a social evening, they take separate cars—just in case.