1
|
Voss JO, Thieme N, Doll C, Hartwig S, Adolphs N, Heiland M, Raguse JD. Penetrating Foreign Bodies in Head and Neck Trauma: A Surgical Challenge. Craniomaxillofac Trauma Reconstr 2018; 11:172-182. [PMID: 30087746 DOI: 10.1055/s-0038-1642035] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 12/29/2017] [Indexed: 10/17/2022] Open
Abstract
Penetrating foreign bodies of different origins in the head and neck are rare and potentially dangerous injuries, which might pose problems for their detection, primary care, and final treatment. Depending on the severity of the underlying trauma, some injuries present a higher risk for the presence of foreign bodies. Minor wounds, including common lacerations, are likely to be contaminated with loose gravel debris or dental fragments, and need to be distinguished from severe wounds caused by impalement, shootings, stabbings, and explosions. Blast injuries resulting from terror attacks are challenging recent therapeutic concepts. Even though these injury patterns are uncommon, they carry the risk of impacted objects with dramatic consequences. Despite improving medical imaging techniques, detection remains a challenge as it is dependent on the material of the foreign body, the affected anatomical site, and the injury severity. Therefore, a detailed history of the circumstances leading to trauma is essential when foreign objects are not visible during clinical examination. Precise detection of the foreign body, its anatomical position, and the affected surrounding structures are vital, especially for impalement injuries of the head and neck area. Therefore, an interdisciplinary planning approach is essential prior to removal of the foreign object. Finally, tension-free anatomical adaptation of the corresponding structures is crucial for maintaining and restoring aesthetic and function. Here, we give an overview of the diagnosis and treatment of cases of foreign body injuries encountered in our department.
Collapse
Affiliation(s)
- Jan Oliver Voss
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany
| | - Nadine Thieme
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universitaät zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany
| | - Christian Doll
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany
| | - Stefan Hartwig
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany
| | - Nicolai Adolphs
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany
| | - Jan-Dirk Raguse
- Department of Oral and Maxillofacial Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Berlin, Germany
| |
Collapse
|
2
|
Uchino H, Kuriyama A, Kimura K, Ikegami T, Fukuoka T. Accidental oropharyngeal impalement injury in children: A report of two cases. J Emerg Trauma Shock 2015; 8:115-8. [PMID: 25949044 PMCID: PMC4411573 DOI: 10.4103/0974-2700.145403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/28/2014] [Indexed: 11/04/2022] Open
Abstract
UNLABELLED Impalement injuries in children may be deeper and more complicated than anticipated. We experienced two cases of accidental impalement injuries, one was through the oral cavity and the other was to the neck. We review these cases and the management of these types of injuries. CASE SERIES In case 1, a 20-month-old girl fell from the table with a toothbrush in her mouth. She was conscious, without any apparent neurologic or vascular injuries. Examination revealed a 2 mm laceration with a small hematoma in the right posterior pharyngeal wall. Contrast-enhanced computed tomography (CECT) revealed an air tract penetrating between the mandibular ramus and cervical vertebrae, passing by the carotid sheath, and reaching under the skin of the right posterior neck. Surgical emphysema was extended from the pharynx to the mediastinum. In case 2, a 3-year-old girl fell while holding a pencil. Physical examination revealed a 5 mm laceration in front of her right ear lobe accompanied by a small hematoma. Her facial movement was asymmetric, and she could not close her right eye. CECT showed swelling of the right parotid gland with heterogeneous enhancement and free air just in front of the right carotid sheath, which suggested the object penetrated through the parotid gland. A diagnosis of peripheral facial nerve injury was made. Physicians need to be aware of the potentially life-threatening complications of impalement injuries in children, as well as the specific complications related to proximity to specific anatomic structures.
Collapse
Affiliation(s)
- Hayaki Uchino
- Department of Emergency Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Akira Kuriyama
- Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Kenji Kimura
- Department of Medical Research and Education, Kurashiki Central Hospital, Okayama, Japan
| | - Tetsunori Ikegami
- Department of Emergency Medicine, Kurashiki Central Hospital, Okayama, Japan
| | - Toshio Fukuoka
- Department of General Medicine, Kurashiki Central Hospital, Okayama, Japan
| |
Collapse
|
3
|
Gupta D, Yadav DK, Panda SS, Panda M, Bagga D, Acharya SK, Anand N, Naredi BK. Transanal impalement of double J steel bar with colonic and jejunal injury: A unique pediatric case report. J Nat Sci Biol Med 2015; 6:217-9. [PMID: 25810666 PMCID: PMC4367041 DOI: 10.4103/0976-9668.149186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Pediatric transanal impalement injuries are relatively uncommon and most are attributed to accidental fall on offending objects, sexual assault or blunt trauma. There may be difficulty in recognizing or properly treating such injuries because their severity may not be reflected externally. Evaluation of suspected rectal impalement injury involves careful history and physical examination and proper investigation. There are very few reports on pediatric perianal impalement with associated visceral injuries. We report a case of assault transanal impalement injury associated with mesenteric tear and jejunal perforation leading to devitalization of proximal jejunum in a 2 year male child and relevant literatures were reviewed. To the best of our knowledge, such dual proximal and distal gastrointestinal injury in such a small child has not been reported in any of the English literature so far.
Collapse
Affiliation(s)
- Divya Gupta
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Devendra Kumar Yadav
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shasanka Shekhar Panda
- Department of Pediatric Surgery, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Meely Panda
- Department of Community Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Deepak Bagga
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Samir Kant Acharya
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Nischal Anand
- Department of Pediatric Surgery, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | | |
Collapse
|
4
|
OYA SHINGO, MIYATA KANJI, YUASA NORIHIRO, TAKEUCHI EIJI, GOTO YASUTOMO, MIYAKE HIDEO, NAGASAWA KEIICHI, KOBAYASHI YOICHIRO. Impalement injury to the left buttock with massive bleeding: a case report. Nagoya J Med Sci 2013; 75:147-52. [PMID: 23544279 PMCID: PMC4345709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
A 67-year-old man fell from the second floor of his home and was impaled on an iron pipe used for a garden stake. The pipe was 2 cm in diameter and had entered his left buttock to his anus. A plain abdominal X-ray film showed that the tip of the pipe was located in front of the 4th lumbar vertebra, so the penetration distance was 30 cm. An emergency operation was performed for hemorrhagic shock. Laparotomy revealed massive intra-abdominal bleeding, injuries of the sigmoid and transverse mesocolon, superior rectal artery, and the first part of the duodenum. Because of suspected lower rectal injury, division of the upper rectum, closure of the rectal stump, and sigmoidostomy were performed. Gauze packing into the pelvic cavity was performed for uncontrollable bleeding. All the gauze was postoperatively removed from the drain wound without laparotomy. Six months after the operation, he underwent a second operation including anastomosis of the descending colon and lower rectum, which allowed him to live a normal daily life.
Collapse
Affiliation(s)
- SHINGO OYA
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - KANJI MIYATA
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - NORIHIRO YUASA
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - EIJI TAKEUCHI
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - YASUTOMO GOTO
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - HIDEO MIYAKE
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - KEIICHI NAGASAWA
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| | - YOICHIRO KOBAYASHI
- Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan
| |
Collapse
|