An unusual penetrating faciocranial injury caused by a knife: A case report

Abstract

Penetrating head and neck trauma in children causes uncommon and potentially life threatening injuries. Penetrating trauma to the head in children is a challenging problem for both the initial evaluating physicians and the surgeons. We reported a patient who had fallen from a tree during cutting vegetables and sustained a penetrating faciocranial injury caused by his knife. Clinical examination showed a knife which had entered his face in the right preauricular, pre temporomandibular joint below zigomatic are. His left bulbus oculi was exophthalmic and a complete ptosis was present. He was fully conscious. There was complete left visual loss. The other neurologic, ophthalmic and systemic physical evaluations were normal. The Glasgow Coma scale was 14. X-Rays showed that the knife entered the right side of the face in the maxillary sinus below the right orbit and crossed the midline at the sphenoid sinus. It passed through the left optic nerve and stopped anterior of the inferior temporal lobe. The knife did not leave the skull. The circle of Willis, the carotids, brain and the brain stem were intact and there was no sign of bleeding in the brain tissue. Left optic nerve was divided and bulbus oculi was exophthalmic. The regular shape of the knife was shown in the cranium. In the operating room, under general anaesthesia via oral tracheal intubation, the knife was extracted by tapping the clamp seized the knife with a surgical hammer via the entry wound. The patient was extubated and monitored in intensive care unit under sedation in 24 hours.