Craniofacial Impalement Injury: Projectile Fragment to the Head

Authors

1 Department of Surgery, Division of Acute Care Surgery and Burns, University of South Alabama, USA

2 Department of Surgery, Wright State University, Dayton, OH, USA

3 Department of Surgery, Division of Neurosurgery, University of South Alabama, Mobile, AL, USA

Abstract

Circular saws and angle grinders are two of the most dangerous pieces of electrical equipment on a worksite. Besides the danger that any
high‑powered, sharp piece of equipment possesses, these pieces use circular saw blades that can splinter into projectile fragments. A 60‑year‑old
male was cutting a steel pipe with a circular saw when a fragment of the 12‑inch blade flew off, impaling him in the upper face just to the
right of the midline. He was wearing eyeglasses, the bridge of which was driven into his skull on impact of the fragment. He was brought to
the trauma center where he underwent imaging of his face and head. This revealed that the blade and his glasses had penetrated 1.2 cm into
the right frontal lobe of the brain, resulting in facial fractures and intraparenchymal hemorrhage. He underwent bifrontal craniotomy, removal
of the blade and his glasses, evacuation of hematoma, and dural reconstruction. Postoperatively, he was awake with a Glasgow Coma Scale
of 15 and no neurologic deficits. The complex nature of craniofacial injuries makes a multidisciplinary approach to these patients essential.
Prompt diagnosis and treatment by the appropriate specialists are vital to optimize patient outcomes.

Keywords


1. Faul M, Xu L, Wald MM, Coronado VG. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalization and Deaths 2002-2006. Atlanta, GA, USA: Centers for Disease Control and Prevention National Center for Injury Prevention and Control; 2010. p. 1-71. Available from: http://www.cdc.gov/traumaticbraininjury/pdf/ blue_book.pdf. [Last accessed on 2017 Mar 03].

2. Langlois JA, Kegler SR, Butler JA, Gotsch KE, Johnson RL, Reichard AA, et al. Traumatic Brain Injury-Related Hospital Discharges: Results from a 14-State Surveillance System, 1997. Washington, DC, USA: Centers for Disease Control and Prevention NCfIPaC, MMWR Surveillance Summaries; 2003. p. 1-18.

3. Adekoya N, Thurman DJ, White DD, Webb KW. Surveillance for traumatic Brain Injury Deaths-United States, 1989-1998. Washington, DC, USA: Centers for Disease Control and Prevention NCfIPaC, MMWR Surveillance Summaries; 2002. p. 1-16.

4. Eppley BL. Craniofacial impalement injury: A rake in the face. J Craniofac Surg 2002;13:35‑7.

5. Selassie AW, Zaloshnja E, Langlois JA, Miller T, Jones P, Steiner C, et al. Incidence of long‑term disability following traumatic brain injury hospitalization, United States, 2003. J Head Trauma Rehabil 2008;23:123‑31.

6. Zaloshnja E, MillerT, LangloisJA, SelassieAW. Prevalence of long‑term disability from traumatic brain injury in the civilian population of the United States, 2005. J Head Trauma Rehabil 2008;23:394‑400.

7. Corrigan JD, Selassie AW, Orman JA. The epidemiology of traumatic brain injury. J Head Trauma Rehabil 2010;25:72‑80.

8. Rusyniak WG, George ED. Missile Injures of the frontal and middle fossa. In: Apuzzo ML, editor. Brain Surgery Complication Avoidance and Management. 1st ed., Vol. 2.Ch. 38. New York, NY, USA: Churchill Livingston; 1993. p. 1335-50.

9. Le TH, Gean AD. Neuroimaging of traumatic brain injury. Mt Sinai J Med 2009;76:145‑62.