Unusual delayed presentation of a nail gun injury through the skull base

Published reports of nail gun injuries to the face are uncommon. We describe an unusual delayed presentation with injury through the infratemporal fossa and a literature review. A 55-year-old patient presented 2 weeks after an unrecognized injury with complaints of a headache. Imaging revealed a nail traversing the infratemporal fossa with intracranial extension. The nail was removed through a preauricular approach without sequelae. Nail gun missiles to the face are uncommon, dramatic, but often nonfatal because of their relative low velocity. Patients are usually diagnosed at the time of injury, evaluated with computed tomography and angiography, and treated with surgery.