Impaled head

Abstract

Although case reports of trauma describe single events only, they can contain very useful scientific information for applied surgery. The portrait of Gregor Baci from the collection of Archduke Ferdinand II of Austria (figure A) provokes the question: is the legend that Baci survived a piercing injury with a lance only a myth, or does medical fact indicate that such severe impalement of the head and neck can be survived? We were able to provide the answer, when a similar case of impalement presented to us. The patient, a craftsman, was injured when a metal bar fell from the ceiling of a church with an altitude of about 14 m, impaling his head in an anterior-posterior direction (figure B). The track of the metal bar followed a mediocaudal line that was near parallel to the Frankfort horizontal line. The bar entered at the anterior wall of the maxillary sinus, passed the pterygopalatine and infratemporal fossa, and exited at a point mediocaudal to the mastoid process. The patient had to undergo surgical treatment twice, and had a year of episodes with headache and moderate diplopia, but now, about 5 years after the accident, the patient does not show any related clinical symptoms. This case shows that even severe penetrating traumas of the head and neck can be survived without sequelae of serious physiological dysfunction. Moreover, some of the penetrating objects are in size and shape similar to surgical tools, and therefore such pathways to deeper structures—eg, the infratemporal fossa—might be feasible for endoscopic skull-base surgery.