A 30-year-old man suffered an accident while carrying a submarine fishing gun at home.
She was sent to the emergency room.
After the protocol "A, B, C", the clinical examination of the patient showed only a penetrating wound at the level of the submandibular region.
The approximate size of the harpoon was 80 cm long and 1 cm in diameter with an intracranial trajectory of about 15 cm. Firefighters carefully cut the harpoon to facilitate transfer of the patient to the hospital.
The patient was hemodynamically stable, alert and oriented (Glasgow 15), without neurological deficit and without active bleeding.
He had blood clots in the left ear canal.
There was no exit of cerebrospinal fluid from the entrance wound or external auditory canal.
Lateral skull radiography showed the trajectory, direction and existence of a beard mechanism in the harpoon.
An emergency CT scan showed the direction of the arrow.
The entrance wound was in the left submandibular region and penetrated to the carotid siphon of the left temporal bone petrous bone petrous sinus.
The harpoon wing was at the level of the left mandibular condyle on its inner side.
Under general anesthesia and nasotracheal intubation, the patient was placed in the supine position and neutral position of the head.
The position of the harpoon adjacent to the left mandibular condyle made oral opening difficult.
In spite of this, the access was performed intraorally at the level of left nostril.
A 4 cm incision was made. This approach was followed by exposure of the harpoon at the level of the loop mechanism.
Subsequently, the barba mechanism of the harpoon was inactivated by ligation with steel wire.
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Finally, under intraoral control, the harpoon was removed contrary to its entry.
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There was no CSF outflow from the entrance wound or through the intraoral access.
Then the intraoral wound was sutured with vicryl 3/0 and subcutaneous vicryl 4/0 and with prolene 4/0 the submandibular wound.
Immediately after the operation, a control CT scan was performed, showing only a small pneumoencephalon.
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The patient was kept under observation for 24 hours without showing neurological focality.
Subsequently, he was discharged on postoperative day 3 without any neurological disorder.
No complications were reported.
One month later, an audiometric test showed 60% loss of conductive hearing in the left ear.
Currently the patient has a normal life and is only waiting for a hearing prosthesis.
