2021 Volume 114 Issue 10 Pages 785-789
Cases of impalement injuries in the head and neck region, such as injuries caused by toothbrush penetration of the oropharyngeal area, are often encountered in the field of pediatric medicine, although facial injuries are relatively rare. In most cases, a part of the object remains lodged in the patient, because the depth of penetration cannot be gauged accurately from the external appearance of the skin or oropharyngeal membrane. Therefore, prompt diagnosis and appropriate treatment are essential to prevent airway obstruction or severe infection which are likely to occur sooner or later depending on the severity and site of the injury. Herein, we present a case of impalement injury caused by the rib of a parasol penetrating the right auricle through to the contralateral submandibular region.
A 73-year-old male patient was struck on his right auricle by the rib of a parasol that was blown away by the wind. He extracted the object by himself, but presented with bleeding from his injured auricle and mouth. Examination revealed an approximately 1-cm laceration on his right auricle, a small hematoma under the right pharyngeal membrane, and slight damage to the pharyngeal mucosa. While computed tomography (CT) did not confirm the presence of a foreign body, it revealed subcutaneous emphysema extending from the auricle to the contralateral submandibular region, indicating the path taken by the penetrating body. Although the patient complained only of the pain caused by his injury, he was admitted for antibiotic therapy, considering the likelihood of his condition worsening. He developed a transient swelling of the left submandibular region and a hematoma development under the laryngeal membrane, but after seven days of conservative treatment, the inflammation improved, and the patient was discharged home.
In general, foreign bodies showing deep tissue penetration as in the present case, should be removed under general anesthesia to avoid major bleeding, although our patient had extracted the object by himself without suffering any complications. In addition, intravenous antibiotic treatment should be administered during hospitalization to prevent infection in cases with deep tissue penetration by a foreign body.
