Facial Impalement

MCBR · #1 ● 09-20-2015, 12:39 PM

A 30 years old male patient was brought to Oral and Maxillofacial surgery casualty of Medical College Kottayam with a penetrating facial injury by a wooden log passing through the left lateral side of his face below the angle of mandible and protruding through oral cavity causing comminuted fracture of mandible after a road traffic accident. There was moderate bleeding and respiratory distress. No history of vomiting or loss of consciousness. From the history it was noted that the wooden branch was initially of length of 8 feet. In the local hospital the wooden log shortened out up to 2 feet and was then referred to Medical College Kottayam.

At the time of admission the patient complained of dyspnea and dysphasia. On examination there was significant oronasopharyngeal bleeding with no neurological deficit. Moderate trickling of blood from the entry site was noted. The blood pressure was 140/90 mmHg and the pulse rate was 110/min. The wooden log was seen protruding through his mouth [Figure 1]. The management of the patient was done by following the advanced trauma life support (ATLS) guidelines established by the American College of Surgeons, which begins with a rapid assessment of the airway, breathing, and circulation. [4] Airway management in such a patient with penetrating injury to the neck was challenging. The patient was unable to lie in supine position due to long wooden log stuck behind the neck. There was high chance of aspiration of blood and saliva. The patient was planned for tracheostomy to secure airway, since the patient was unable to lie down in the supine position due to obstruction of wooden log posteriorly. Therefore the wooden log was shortened out near close proximity to the left retromandibular region [Figure 2]. The patient was then positioned on right lateral and tracheotomy was performed under sedation and local anesthesia. General anesthesia was then administered through the tracheostome [Figure 3]. With the airway secured, breathing and circulation were evaluated and managed in the standard manner, following the ATLS protocol. The secondary survey was conducted after the patient was initially stabilized. There were no other associated injuries.

ludokressh · #2 ● 09-20-2015, 02:07 PM

Holy shit on toast!

CrunchyCripple · #3 ● 09-20-2015, 02:26 PM

Holy hell!

mintycbo · #4 ● 09-20-2015, 09:27 PM

Originally Posted by ludokressh ↗

Holy shit on toast!

mintycbo · #5 ● 09-20-2015, 09:31 PM

Very nice job on the repair..

India does have some good docs. Had an Indian doctor repair a hernia on me when I was 10 yrs. old.(1990)
Fast forward to 2010, same doctor, repaired my 2nd hernia.

Not one problem with either.. recovery sucks regardless for the procedure though..lol

That was one "lucky" gentleman... he looked about as good as a human shish kebab..