Craniofacial impalement injury: Projectile fragment to the head

Circular saws and angle grinders are two of the most dangerous pieces of electrical equipment on a worksite. Besides the danger that any high-powered, sharp piece of equipment possesses, these pieces use circular saw blades that can splinter into projectile fragments. A 60-year-old 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 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 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 the right frontal lobe of the brain, resulting in facial fractures and intraparenchymal hemorrhage. He underwent bifrontal craniotomy, removal of the blade and his glasses, evacuation of hematoma, and dural reconstruction. Postoperatively, he was awake with a Glasgow Coma Scale of 15 and no neurologic deficits. The complex nature of craniofacial injuries makes a multidisciplinary approach to these patients essential. Prompt diagnosis and treatment by the appropriate specialists are vital to optimize patient outcomes.