A 30yo patient was brought to Oral and Maxillofacial surgery department with a penetrating facial injury by a wooden log passing through the lateral side of his face below the angle of mandible and protruding through oral cavity, causing comminuted fracture of mandible after a road traffic accident.
There was moderate bleeding and respiratory distress. On examination there was significant bleeding with no neurological deficit. Moderate trickling of blood from the entry site was noted. The blood pressure was 140/90mmHg and the puls rate was 110/min.
The management of the patient was done by following the advanced trauma life support (ATLS), which begins with a rapid assessment of the airway, breathing and circulation. Airway management in such patient with penetrating injury to the neck was challenging. The patient was unable to lie in supine position due to long wooden log stuck behind the neck. There was high chance of aspiration of blood and saliva. The patient was planned for tracheostomy to secure airway. Therefore the wooden log was shortened out near close proximity to the left retros fibular region. General anesthesia was then administrated through the tracheostome.
After adequate exposure the wooden log was removed. Lingual and facial artery were identified and ligated with 2-0 silk. Hemostasis was achieved and the area cleaned with betadine saline wash. There was no damage to great vessels and nerves of neck. Reduction and fixation of fracture mandible was done by stainless steel mini plates and screws. Wound was then closed in layers after securing the suction drain.
Post operative evuluation showed no injury to facial and lingual nerve. The patient had an uneventful postoperative period and was discharged on the 10th day with tracheostomy tube removed. After one month he showed no functional or major aesthetic problems.