[hermantheshocker]

Kottayam, India. 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 the mandible and protruding through the oral cavity causing comminuted fracture of the 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 the length of 8 feet. In the local hospital, the wooden log was shortened to 2 feet.


Fig.1 Front view of patient.

At the time of admission the patient complained of dyspnea and dysphasia. On examination there was significant oronasopharyngeal bleeding with no neurological deficit. A moderate trickling of blood from the entry site was noted. The wooden log was seen protruding through his mouth. 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. The patient was unable to lie in a supine position due to the wooden log stuck behind the neck. Tracheotomy was performed under sedation and local anesthesia. General anesthesia was then administered. There were no other associated injuries.


Fig2. Wooden log shortened out in right lateral position.


Fig.3 Airway secure through tracheostomy.

A midline lip-split incision was given till the anterior extension of the penetrating wound. Exploration was performed through existing mandibular symphysis fracture. Comminuted fracture of the left body of the mandible and symphysis were identified. Access was gained by swinging the mandible through the fracture symphysis (Fig.4). After adequate exposure, the wooden log was removed in toto (as a whole) (Fig.5). There was no injury to great vessels and nerves of the neck. Reduction and fixation of fracture mandible were done by stainless steel mini pates and screws (Fig.6). The wound was then closed in layers after securing the suction drain. CT scan revealed that there were no associated head injury, cervical spine injury, maxillofacial injury, or any other foreign body.


Fig.4 Access through mandibular swing.


Fig.5 Removal of wooden log.


Fig.6 Reduction & fixation of mandible.

The postoperative evaluation showed no injury to the facial and lingual nerve. The patient had an uneventful postoperative period and was discharged on the 10th day with the tracheostomy tube removed. He was followed up regularly. A 1-month review showed no functional or major aesthetic problems (Fig.7).


Fig.7 Post operative facial photograph of patient.

Penetrating injuries of the face and neck though uncommon are potentially life-threatening entities. Many cases of penetrating neck injuries that required massive surgical intervention and repair have been reported. Initial clinical presentations sometimes may not reflect the true injury that has occurred internally. A clinically superficial-looking minor stab wound can have a vascular or aerodigestive injury when the wound is explored.

[kellyhound]

i must admit, the docs did a very good job fixing that

[Hogmann]

I thought the title said wooden "LEG"

[journey2xl]

Impressive.....Amazing even!!!

[bjol]

Thats really unlucky, he looks good after

[ChristySD]

Lucky motherfucker!!!! The major arteries and vessels that are within millimeters of this area?!?! Not to mention spinal cord, trachea, etc. I have to applaud not only the surgeons, but the emergency personnel that handled his care on the scene. Had they not secured the branch, it may have shifted and caused catastrophic damage.

[TheNiceSliencer]

Thank heaven for modern medicine we have today in the end it did not look like anything major happened

[gnslngr]

I gotta admit I generally consider India a third world backwater, apart from a few tech centers like Bangalore, but so many of these traumatic injury posts have been out of India and the repairs these guys have been able to pull off are fucking amazing, if they didn't have the scar tissue you would never know they got their face caught in a combine or ate some dynamite.