Retained Crossbow Bolt after Penetrating Facial Trauma

Abstract

Objective: 1) Describe a challenging case of removal of a retained crossbow bolt from the maxillofacial region. 2) Review the surgical management techniques. 3) Review of the literature on crossbow injuries to the head and neck. Method: Case report is of a unique mechanism of penetrating maxillofacial trauma with retained foreign body threatening airway and neurovascular injury. Pertinent literature is reviewed. Results: A 31-year-old man presented after being shot twice in the head with crossbow bolts. He was stable on clinical evaluation, and CT revealed an 8.5-cm retained crossbow bolt extending from the right infratemporal fossa through the pterygopalatine fossa, traversing the nasopharynx with the tip just medial to the left mandibular ramus. There was no apparent vascular injury on CT angiogram. After awake tracheostomy for airway control, the bolt was removed by mandibular swing approach combined with nasal endoscopic assistance. Postoperative course was uneventful and follow-up showed excellent wound healing without complications. Conclusion: Otolaryngologists often encounter penetrating injuries and retained foreign bodies to the maxillofacial region. The unique shape of a crossbow bolt, along with threat of airway and neurovascular injury, created a management challenge. Herein we discuss various surgical approaches and review the literature on crossbow injuries to the head and neck.