Management of an Unusual Craniofacial Impalement Injury by a Metallic Foreign Body

Craniofacial penetrating injuries caused by foreign bodies other than bullets or glass from traffic crashes are quite rare. Hence, there is a lack of knowledge regarding systematic management strategies or analysis of complications for craniomaxillofacial surgeons. Between 2002 and 2010, 82 patients underwent surgery for penetrating craniofacial injuries in 2 craniomaxillofacial trauma centers. Among these patients, we included patients who had retained foreign metallic bodies. Data regarding age, sex, injury materials, entrance, injured structures, operative records, and complications were reviewed retrospectively for 8 patients. All of the patients were evaluated precisely in the emergency department without removal of retained materials, and a multidisciplinary team approach was performed for the removal of the foreign body under general anesthesia.In this study, 6 men and 2 women presented with penetrating injuries that retained metal objects. The mean age of the patients was 44.3 years. All of the patients were hemodynamically stable, and no active bleeding was found. However, all of the patients had postoperative complications. Three patients had damaged vascular structures, and 3 patients had injuries to facial nerve branches. Seven patients had posttraumatic stress disorder. Two patients underwent subsequent emergent procedures because of massive bleeding and cerebrospinal fluid leakage.Penetrating injuries in the head and neck regions are complicated. Although a multidisciplinary team approach was performed from initial management to outpatient management in patients with unusual impalement injuries, numerous postoperative complications still remained. Preoperative patient informed consent was important.