Jael syndrome: removal of a knife blade impacted in the maxillofacial region under local anaesthesia

Abstract

The presence of retained foreign bodies in the maxillofacial region as a consequence of penetrating injuries from knives is poorly documented in the scientific literature. This manuscript reports the case of a 30-year-old Caucasian with a knife blade lodged in the maxillofacial skeleton. Following clinical and radiographic exams, it was determined that the object had penetrated through the left nostril and nasal septum, in the direction of the right maxillary sinus, and remained impacted without causing injury to important anatomical structures. After systemic assessment and determination of the exact location of the knife blade, the object was removed in an outpatient setting under local anaesthesia. This manuscript aims to report a rare case of a transfacial penetrating injury involving a knife blade that was removed in an outpatient setting while also discussing the proper conduct and treatment options for similar cases in the context of a brief literature review.

Multiple foreign bodies in the facial region from a penetrating stab injury

“…Retained foreign bodies following penetrating trauma may pose a difficult diagnostic problem,2 due to several factors such as the difficult access, the inflammatory response of the tissues around, the size of the object and a close anatomic relationship to vital structures, which may put patients’ lives at risk 5…”

“…Removal of retained foreign bodies in the maxillofacial region may not follow a structured pattern due to varied mechanisms of injury, different length and shapes of the objects,5 closeness to large blood vessels and the varied extent of damage of the facial tissues. However, precise localisation and reasonable surgical approaches12 should be adopted to limit the risk of morbidity and mortality.…”

“…Following facial trauma, foreign bodies like grit particles, wooden pieces, thorns, pebbles and glass particles may get embedded into deeper facial tissues 12 blade of grass3 and gauze material,4 or radiopaque ones like knife blade,5 root canal filling material,6 pebble1 and broken tips of probe 71.…”

Applications of digital subtraction angiography in the management of penetrating injuries of the maxillofacial region: A case report

“…Penetrating injuries in the maxillofacial region are uncommon;8 therefore few cases in the literature have been documented 9. In a review of 37 penetrating injuries involving this region, only 4 were caused by a knife 10…”

Long-standing Blades of Scissors in paranasal sinus over 40 years

“…Guidelines on some factors have been reported by surgeons in regard to the location of the foreign body, proximity to vital neurovascular anatomical structures, duration of foreign body impact, and risk of surgical retrieval. 1,2 In this article, we describe an unusual case of a transfacial penetrating injury with a metallic foreign body (blades of scissors) that remained asymptomatic for about 40 years and was successfully removed via an endoscopic approach. Furthermore, we aim to address issues about management of foreign bodies in the sinonasal cavity to provide guidance and aid in decision-making and treatment processes.…”