Penetrating Foreign Bodies in Head and Neck Trauma: A Surgical Challenge

Abstract

Penetrating foreign bodies of different origins in the head and neck are rare and potentially dangerous injuries, which might pose problems for their detection, primary care, and final treatment. Depending on the severity of the underlying trauma, some injuries present a higher risk for the presence of foreign bodies. Minor wounds, including common lacerations, are likely to be contaminated with loose gravel debris or dental fragments, and need to be distinguished from severe wounds caused by impalement, shootings, stabbings, and explosions. Blast injuries resulting from terror attacks are challenging recent therapeutic concepts. Even though these injury patterns are uncommon, they carry the risk of impacted objects with dramatic consequences. Despite improving medical imaging techniques, detection remains a challenge as it is dependent on the material of the foreign body, the affected anatomical site, and the injury severity. Therefore, a detailed history of the circumstances leading to trauma is essential when foreign objects are not visible during clinical examination. Precise detection of the foreign body, its anatomical position, and the affected surrounding structures are vital, especially for impalement injuries of the head and neck area. Therefore, an interdisciplinary planning approach is essential prior to removal of the foreign object. Finally, tension-free anatomical adaptation of the corresponding structures is crucial for maintaining and restoring aesthetic and function. Here, we give an overview of the diagnosis and treatment of cases of foreign body injuries encountered in our department.

Unrevealed foreign body in the deep neck space: A case report

“…[3][4][5][6][7][8][9] Moreover, retained foreign bodies might lead to long-term sequelae as chronic infection and neurological or functional impairment. 2 Foreign bodies as etiology cause of DNSI are extremely rare. [6][7][8] Si-Youn Song et al described a 50-year-old patient with a blade of a grass cutter suddenly dislodged on impact and penetrated his neck.…”

“…1 Radiological investigations are fundamental for diagnosis and surgical programming, as the foreign body is not always evident at the clinical examination. 2 For this reason, anamnestic collection remains pivotal to direct the diagnostic workup and to prevent delayed treatments and complications.…”

Imaging foreign bodies in head and neck trauma: a pictorial review

“…The spectrum of metal foreign body injuries includes a broad range of traumatic larger objects e.g. bullets, metals parts from improvised explosive devices, blades, drilling devices or keys [ 14 ], but smaller objects such as wires, metallic splinters, incorporated batteries or coins are also regularly seen in our hospital, requiring a diligent clinical and morphological imaging procedure. Overall, metal foreign bodies are more or less easy to detect depending on their overall size and anatomical location [ 32 ].…”

“…Foreign body injuries carry a risk of acute and potentially life-threatening complications such as bleeding, airway compromise or neurovascular injury [11][12][13][14]. While some retained foreign bodies may remain clinically silent for years or even indefinitely, there is a general risk of late sequelae, primarily in the form of infections, which can result in persisting impairment [7,[15][16][17].…”

Pediatric Gunshot Wound to Visual Cortex with Retained Bullet: Case Report and Review of the Literature

“…Kazim et al [5] recommend against routine surgical removal of bone or missile fragments lodged distant from the entry site, especially in the eloquent areas of the brain, and a few studies report the low likelihood of the development of epilepsy or an abscess with retained bullets [5-7]. However, other authors suggest that retained foreign objects should be removed to avoid acute/chronic infection, lead toxicity, or moving bullet syndrome [8-10].…”