[A case of craniofacial injury by javelin]

We report a case of 16-year-old woman with craniofacial impalement injury by javelin (used by athletic sports) thrown from a distance of 30 meters. When the patient was admitted to the emergency department, the javelin had been in the orbita, and the patient was assessed by trauma team including an anesthesiologist. The patient was alert and complained of severe pain. Head CT and X-ray indicated the javelin had entered though the orbita into the maxillary sinus. Sphenoidal sinus was also partly destroyed by the impact. Anesthesia was soon induced in the emergency room to release the patient from the unbearable pain. To avoid tension cephalus, awake fiberscopic endtracheal intubation was performed. Anesthesia was maintained with propofol, vecuronium and fentanyl before transporting the patient to an operating room. The javelin and her head were strongly fixed with fiber cast to prevent from moving while she was transported to the operating room. The javelin was successfully removed during the operation. The fractures were fixed, and lacerations were sutured. The most important principle of management with craniofacial impalement injury is that the impaling object should remain in situ while patient is rapidly transported to an operating room, since it could extend tissue injury, and have a tamponade-like effect on damaged vascular structure.