Oropharyngeal impalement injury traversing the parapharyngeal space in a child

Oropharyngeal impalement injuries in children are uncommon but potentially life-threatening, due to the proximity of vital neurovascular structures and the risk of airway obstruction. We report the case of a child who sustained an impalement injury from a reinforcement bar that penetrated the oropharynx, traversed the parapharyngeal space and exited near the preauricular region. Given the potential for disastrous complications, such as carotid artery blowout or need for surgical airway, the patient was managed by a multidisciplinary team including experienced anaesthetists, ENT, and vascular surgeons. Awake fibreoptic nasotracheal intubation was performed, followed by surgical removal of the object and primary repair of the oropharyngeal laceration under general anaesthesia. Despite the fact that the patient developed a transient grade III facial nerve palsy, which resolved over six months, no major structures were damaged. This case highlights the importance of early multidisciplinary involvement, advanced airway planning and awareness of neurovascular complications when approaching oropharyngeal trauma.