A rare motobike accident: a young man had his face pierced by a metal bar

15/03/2021 07:30

Recently, L.V.C., 20, a native of Lai Chau, was admitted to the Viet Duc University Hospital (VDUH) because his face was pierced by a metal bar.  The 12mm diameter by 12 cm long metal bar pierced through his face from nose to brain, passing his ethmoid sinus. His family said when L.V.C was riding a motorbike, he suddenly fell into the roadside fence. He had to stay put and waited for local medical staff to free him with a saw machine and took him to VDUH with part of the rod still lodged in his face.

 

 

Mr. Vu Trung Truc, MD, MS, (Deputy Chief of Maxillofacial, Plastic and Aesthetic Surgery, VDUH) said: “The patient was transported to emergency with stable blood pressure and pulse however he was quite hysterical. He was diagnosed with traumatic brain injury and ocular trauma (mydriasis, ophthalmoplegia). Multidisciplinary team has consulted to determine the exact position of the metal bar. It broked through skin under the left eye, passed ethmoid sinus, fractured the base of the skull and punctured the right temporal lobe, missing the right medial carotid artery by only 5mm. If said artery were damaged, it might have cost the patient his life. Furthermore, the part of the bar lodged inside the brain was shaped like a hook, so if the bar was carelessly removed there was a high risk of damaging the carotid artery, endangering of the patient’s life. Safely removing said rod posed a sizable challenge to our doctors.

 

The patient was rushed into Digital Subtraction Angiography (DSA) room with a team of doctors consisting of many specialties: neurosurgery, maxillofacial surgery, ophthalmology, diagnostic imaging, anesthesiology & resuscitation. Thank to modern DSA system, 3D angiography determined the exact position of the foreign body related to the medial carotid artery. The bar was safely removed by directly observing under DSA.

 

Mr.Le Thanh Dung, MD,PhD, (Chief of Diagnostic Imaging department, VDUH) said: “We were fully prepared for the worst case scenario. If the medial carotid artery was damaged during the removal, we would embolize it immediately. In case embolization was failed, the patient would have been immediately rushed into operating room so the neurosurgery team can operate.

 

After the foreign body was removed, the maxillofacial surgery team took over and treated for wound, stuffed nose mesh to stop bleeding. The patient would be closely monitored for the next 3 – 4 days and treated for any complications occurred. Mr.Vu Trung Truc, MD, MS, who removed the foreign body, shared: “We were extremely tense and could only let out a sigh of relief when the bar  was successfully removed. Thanks to modern equipment, we could calculate the exact direction and angle in which to pull the bar so as to not damage the carotid artery. Additionally, one of the hospital’s strength is the smooth coordination among different specialties ensuring the best treatment for all patients on emergency.

 

 

Mr.Ngo Manh Hung, PhD., M.D. (Deputy Chief of Neurosurgery II, VDUH) said: “The bar punctured the meninges, which posed a risk of cerebrospinal fluid fistula. In the second day post-op, the patient showed no signs of cerebrospinal fluid fistula and we continued to monitor him and placed him on an antibiotic treatment to prevent infection. Currently, the patient’s visual acuity is not impaired. However, he had ptosis and ophthalmoplegia of the right eye. We plan to transfer the patient to the Ophthalmology Hospital to continue treatment when his condition is stable. The spectacular emergency treatment of this rare accident lasted for 2 consecutive hours with amazing coordination from our many specialists: neurosurgeons, maxillofacial surgeons, ophthalmologists, radiologists, anesthesiologists… along with a system of modern equipment. The young man was saved, promising more opportunities for treating life-threatening emergencies in the future.