Foreign bodies in the paranasal sinuses are rare. Typically, air gun injuries occur in adolescent males . Most are associated with trauma in the maxillofacial region followed by dislodgement of teeth or surgical intervention for dental problems . Infrequently, gunshot injuries are responsible for foreign particles in the paranasal sinuses. Maxillofacial gunshot injuries are rare and generally presented in case reports ( Table 1 ). Air gun pellet injury may cause major damage to soft tissue or bone or other severe problems. Some metals, embedded in body tissue, can be a source of potential exposure to toxic effects . Little is known about the health effects of lead-containing air gun pellets after internalisation in body cavities. There is ambiguity in the literature about whether to remove metal-containing foreign bodies, particularly air gun pellets, or to leave them in situ. Microinvasive techniques (e.g. endoscopy) have reduced the surgical stress and comorbidity of surgical intervention, so the decision to remove foreign bodies is now made earlier and more often. The aim should be the prevention of long-term sequelae for the patient.

Table 1

Summary of reports on low-velocity gun injuries in paranasal sinuses.

References	Age/gender	Type of pellet	Sinus	Signs of infection, toxicity, tumor	Surgical approach	Period in situ	Outcome
Ogale et al.	3 year/female	air gun	sphenoid	chemosis, eye congestion	transnasal	unknown	uneventful
Murthy et al.	1 year/male	air gun	ethmoid	Unknown	endoscopic failed/extern.ethmoidectomy	unknown	uneventful
ÓConnell et al.	1. 12 year/male	air gun	1. maxillary	Unknown	1. Caldwell.Luc	unknown	1. uneventful
	2. 16 year/male		2. maxillary		2. Caldwell.Luc		2. unknown
	3. 14 year/male		3. sphenoid		3. transethmoidal		3. eye damage
Lubianca Neto et al.	15 year/female	air gun dart	ethmoid/sphenoid	visual problems, ocular pain	no removal	34 months	moderate visual loss
Mahajan and Shah	6 year/female	air gun	maxillary	asymptomatic sinusitis	no removal	unknown	chronic sinusitis
Strek et al.	15 year/male	air gun	sphenoid		endoscopic		uneventful
Badran et al.	17 year/male	air gun	ethmoid	brief epistaxis	endoscopic	1-2 hours	uneventful
Hyckel et al.	unknown	air gun	maxillary	Unknown	endoscopic	unknown	unknown
Cohen et al.	unknown	low-velocity	maxillary 2 cases	Unknown	unknown	unknown	unknown
Chhetri and Shapiro	10 year/female	BB gun	ethmoid	Unknown	endoscopic	unknown	unknown
Akhtar et al.	41 year/male	missile	sphenoid	Unknown	transmaxillary	unknown	unknown
Lee et al.	6-63year/	low-velocity	maxillary:27	vascular injuries:4	removed:16	unknown	death:3
	33male,2female		ethmoid:20	ocular injuries	not removed:5		eye injury:9 (blindness:3)
			frontal:6		unknown:14		nerve injury:15
			sphenoid:5				sinusitis:4
Brinson et al.	1. 8 year/female	air gun	1. maxillary	1. hypesthesia	1. endoscopic	1. 2 weeks	1. uneventful
	2. 15 year/male	BB gun	2. ethmoid	2. headache,	2. antrostomy,	2. 3 weeks	2. uneventful
	3. 8 year/male	BB gun	3. sphenoid	epistaxis	ethmoidectomy,	3. several	3. enucleation
				3. no light	sphenoid sinustomy,	weeks
				perception,	stereotactic guidance
				headache	3. sphenoidotomy,
					stereotactic guidance
Donald and Gadre	19 year/female	air gun	ethmoid	neuralgia-like symptoms	endoscopic	unknown	uneventful

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