A rare case of a penetrating injury extending from the mental region to the skull base is reported. A 32-year-old man was referred to our hospital because of a nail stuck in his mouth. There was swelling of the left eyelid and a stab wound in the mental region. He was fully conscious and neurologically intact, but could not speak because of the nail. On skull X-ray films, the nail was seen in the midface, passing obliquely through the left orbital apex in the direction of the anterior cranial fossa. A computed tomographic scan showed that the tip of the nail reached the orbital roof, but there were no signs of brain damage. The nail was extracted via an intraoral approach with the patient under neuroleptic-induced analgesia. There was slight bleeding but no leakage of spinal fluid. The patient concurrently received antitetanus serum, tetanus toxoid, and antibiotics. He was discharged on the 15 day without any complications.
