Craniofacial Impalement Injury: Projectile Fragment to the Head

Abstract

Circular saws and angle grinders are two of the most dangerous pieces of electrical equipment on a worksite. Besides the danger that any<br /> high‑powered, sharp piece of equipment possesses, these pieces use circular saw blades that can splinter into projectile fragments. A 60‑year‑old<br /> male was cutting a steel pipe with a circular saw when a fragment of the 12‑inch blade flew off, impaling him in the upper face just to the<br /> right of the midline. He was wearing eyeglasses, the bridge of which was driven into his skull on impact of the fragment. He was brought to<br /> the trauma center where he underwent imaging of his face and head. This revealed that the blade and his glasses had penetrated 1.2 cm into<br /> the right frontal lobe of the brain, resulting in facial fractures and intraparenchymal hemorrhage. He underwent bifrontal craniotomy, removal<br /> of the blade and his glasses, evacuation of hematoma, and dural reconstruction. Postoperatively, he was awake with a Glasgow Coma Scale<br /> of 15 and no neurologic deficits. The complex nature of craniofacial injuries makes a multidisciplinary approach to these patients essential.<br /> Prompt diagnosis and treatment by the appropriate specialists are vital to optimize patient outcomes.