Craniofacial Impalement Injury: Projectile Fragment to the Head


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



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.


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