Rare case of penetrating craniofacial trauma without injuring major neck vessels and facial nerve.
A 15-year-old boy presented to the emergency department with penetrating craniofacial trauma. The boy fell from a tree onto a wooden fence which caused a penetrating injury from a wooden piece. On examination, the patient was well-oriented and conscious. He was brought to the emergency 30 minutes after the incident. He was given 1 ml and 0.5 mg tetanus vaccine. He complained of pain over the site of injury.
Physical examination showed stable vitals with a pulse rate of 80/min and blood pressure 120/80 mmHg. Facial nerve examination showed no evidence of facial nerve injury. CT scan of the face revealed that the foreign body was superficial to the investing layer of deep cervical fascia. All major neurovascular structures were intact. The foreign body was a linear hypo dense structure located in the plane superficial to the parotid fascia and extended to the superficial fascia.
Treatment plan
After the foreign object was identified the foreign body was surgically removed under general anaesthesia to prevent neurovascular damage. There were no signs of bleeding after the surgery. The patient was kept in the intensive care unit for monitoring vital signs and for haematoma. There was minimal haematoma on the injury site the first postoperative day which was managed conservatively.
The patient was evaluated for facial nerve and parotid duct injury on the second postoperative day. The patient was discharged a week after surgery. However, 2 weeks after the procedure, the patient presented with swelling in the preauricular region. There was minimal fluid collection that resolved after 2 days. The patient was called in for a follow-up regularly for 6 months. Wound healing was satisfactory with no signs pf facial nerve paralysis or sialocele (localized, subcutaneous cavity containing saliva).
References
An Interesting Case of Penetrating Craniofacial Trauma Involving a Wooden Stick https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866261/
