Jael syndrome, or the nasty arrow

Area of Science:

• Trauma Surgery
• Neurosurgery
• Emergency Medicine

Background:

• Jael syndrome describes penetrating craniofacial trauma with an in-situ foreign body, named after a biblical event.
• This rare condition poses significant risks of mortality, neurological deficits, and functional impairment.
• Historical and artistic references highlight the symbolic nature of this unique injury pattern.

Purpose of the Study:

• To review diagnostic and therapeutic strategies for Jael syndrome.
• To emphasize the importance of multidisciplinary teamwork and specialized care in managing these complex injuries.
• To discuss current management principles and the need for further research.

Main Methods:

• Case presentation of penetrating facial trauma involving an arrow.
• Review of diagnostic modalities, including head-and-neck CT angiography.
• Discussion of management principles based on ATLS® (Advanced Trauma Life Support) algorithm and clinical assessment.

Main Results:

• Effective management relies on a systematic approach: ABCDE assessment, foreign body in-situ, airway/vascular protection, and appropriate imaging.
• Personalized, selective management is favored over systematic surgical exploration, guided by clinical findings and stability.
• Tertiary referral centers with multidisciplinary teams are essential for optimal outcomes.

Conclusions:

• Jael syndrome requires specialized, multidisciplinary care in a tertiary setting.
• Current management emphasizes clinical assessment, advanced imaging, and tailored treatment strategies.
• Further multicenter prospective studies are needed to refine guidelines and improve functional prognosis through advanced techniques.