Internal Carotid Injury Secondary to Impalement Injury in the Oral Cavity by a Toothbrush in an Infant Patient : A Case Report

Abstract

  Penetrating injuries in the oral cavity, leading to cervical carotid artery dissection and subsequent cerebral infarction, frequently occur in cases of severe accidents, such as falls and traffic accidents. Furthermore, impalement injuries secondary to forward falls involving objects in the oral cavity of children are relatively common in emergency departments ; however, the risk of surrounding vascular injuries may be underestimated. Herein, we report a case of dissection of the left internal carotid artery (ICA) due to blunt pharyngeal injury caused by a toothbrush. Radiological examination revealed ICA dissection proximal to the foramen lacerum. The dissection mechanism was speculated to involve a shear force, which is consistent with the mild injury to the pharynx detected by fiberscopic observation. Because of immature anatomical structures, the combination of force and hyperextension of the craniocervical junction can result in ICA injury in this age group. A literature search revealed similar cases of severe ICA occlusion following impalement injury in children. In addition, according to the literature review, patients can experience some delay (ranging from 1 to 48 hours) before the onset of symptoms. Therefore, in cases of oral injury in pediatric patients where the injury is not so severe, it is important to keep in mind that there may still be a potential risk of vascular injury after impalement injury and some delay in the time of onset, as in the present case.