Oropharyngeal impalement on a wrought iron fence

Oropharyngeal impalement is a potentially life-threatening injury with protean manifestations. Attention to airway obstruction and active hemorrhage take initial priority. Foreign bodies are not removed outside the operating room unless they are causing immediately life-threatening compromise. The majority of injuries that cause thrombosis of the internal carotid artery are in the peritonsillar region of the lateral palate. These patients typically have a delayed onset of symptoms, sometimes more than 24 hours, so close observation is warranted.