Transoral Penetrating Knife Injury in the Oral, Maxillofacial Region: A Case Report

Abstract

Penetrating injuries are a rare yet complex variety of oral and maxillofacial trauma and often require a multidisciplinary approach to treatment. The primary survey is always the first step in trauma management prior to proceeding with further evaluation and treatment. The following case report discusses the clinical strategy for a rare transoral and trans-spinal penetrating injury. A 42-year-old man presented with a penetrating metal injury through the oral cavity. A computed tomography scan revealed a 12.8-cm-long knife penetrating through the tongue, floor of the mouth, and hypopharynx reaching the spinal cord in close proximity to the right vertebral artery. The patient did not present with any neurological malfunctions. An emergency tracheotomy was performed for airway protection. A balloon catheter was inserted into the right vertebral artery using interventional angiography to prevent massive bleeding prior to extraction. The knife was then surgically removed, and soft tissue reconstruction was performed without major bleeding. Postoperative magnetic resonance imaging angiography showed no bleeding of the right vertebral artery, but there was mild cerebellar infarction. Early isolated paresis of the right arm returned to nearly normal function within 1 week. This case demonstrates that complex penetrating injuries of the oral and maxillofacial region require a structured and multidisciplinary approach to prevent further side effects and obtain an ideal clinical outcome.