Archives of Orofacial Sciences
The Journal of the School of Dental Sciences
Universiti Sains Malaysia
Arch Orofac Sci (2011), 6(2): 86-88.
Quiz
Post motor vehicle accident with multiple jagged
laceration wound
Irfan Mohamad a*, Puvan Arul Arumugam a, Nik Fariza Husna Nik Hassan a,b
a
Department of Otorhinolaryngology-Head & Neck Surgery, School of Medical Sciences,
Health Sciences, Universiti Sains Malaysia, 16150 Kota Bharu, Kelantan, Malaysia.
b
School of
* Corresponding author: [email protected]
Received: 29/09/2011. Accepted: 11/12/2011. Published online: 11/12/2011.
Panel 2
Panel 1
An 11-year-old Malay boy was allegedly involved in motor vehicle accident. He
sustained left lung contusion and pneumothorax which necessitate chest tube
insertion at a district hospital. On arrival at Accident & Emergency Unit, general
physical examination was performed. Neck examination revealed multiple jagged
lacerations wound on the left side of the neck (Panel 1).
Questions
Panel 1
Q1: Describe the findings in Panel 1.
Q2: What is the suspected associated problem?
Panel 2
Q3: What are the findings in Panel 2?
Q4: What is the next step of management?
(Answers are on page 48)
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Irfan et al. / Post motor vehicle accident with multiple jagged laceration wound
anticipated (Halaas, 2007). However,
obtaining the history may be incomplete
and many of the victims are
unconscious or could not recall the
exact impact of the incident. Fortunately
as demonstrated in this case, glass
foreign body showed good opacity on
plain radiograph (Orlinsky and Bright,
2006). If the suspected embedded
foreign
bodies
were
radiolucent
materials, ultrasonography offers a good
visualization and localization with
sensitivity. The foreign bodies especially
wooden or plastic in origin, which
sometimes undetectable on plain x-ray,
xerography and even CT scan can
clearly
be
identified
with
ultrasonography providing detectable
echogenic
source
with
acoustic
shadowing (Ginsburg et al., 1990).
Retained foreign bodies, especially the
sharp-edged one such as glasses and
metal piece can lead to injury to the vital
structures in the neck.
In some circumstances, foreign
body embedded in the neck can also be
directly visualized during the clinical
inspection of the neck wound. Finger
exploration of the wound in searching
for the foreign body should be avoided
especially in the glass type of foreign
body because of the risk of puncturing
the finger, even though gloved, and
subsequently exposed the medical
attendant to blood-borne diseases
(Halaas, 2007). A proper wound
evaluation under general anaesthesia is
indicated.
With the help of intra-operative
imaging modalities such as image
intensifier (II) the possibility of missing
the foreign body can be best avoided. It
provides the real time intra-operative
assessment of the completeness of
removal. Owing to its difficult access
and delicate anatomy of many vital
structures in the neck, the Image-guided
surgical (IGS) navigation tool has also
been proven to be very effective
especially for removal of foreign bodies
from the head and neck area. Thus,
major complications such as injury to
vital structures can be prevented
Patient outcome
A chest radiograph was obtained and
revealed several foreign bodies (Panel
2). The dirty wound was irrigated and 6
pieces of glasses were flushed out. He
underwent wound exploration, removal
of foreign bodies under Image intensifier
(II) followed by toilet and suturing (T&S)
under general anaesthesia. Another 5
pieces were removed in the theatre. A
repeat neck x-ray showed no more
embedded foreign body (Panel 3). The
patient was discharged well after
showed good outcome at the local site
of injury and general well being.
Panel 3
Discussion
Foreign body in the neck is common
especially following windscreen blast
during a motor vehicle accident (MVA).
Multiple pieces of glass may be
embedded in the neck soft tissues, and
the possibility of retained glass can be
as high as in 15% of wounds (Steele et
al., 1998). It is important to confirm the
presence of any foreign material
embedded, even though inert in nature,
before the patient can be discharged.
Any open wound, regardless the size;
following a motor vehicle accident must
be evaluated to determine the necessity
of exploration.
Mechanism of injury must be
detailed out from the history so that
presence of foreign body can be
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Irfan et al. / Post motor vehicle accident with multiple jagged laceration wound
Orlinsky M, Bright AA (2006). The utility of
routine x-rays in all glass-caused wounds.
Am J Emerg Med, 24(2): 233-236.
Siessegger M, Mischkowski RA, Schneider BT,
Krug B, Klesper B, Zöller JE (2001). Image
guided surgical navigation for removal of
foreign bodies in the head and neck. J
Craniomaxillofac Surg, 29(6): 321-325.
Steele MT, Tran LV, Watson WA, Muelleman
RL (1998). Retained glass foreign bodies in
wounds: predictive value of wound
characteristics, patient perception, and
wound exploration. Am J Emerg Med, 16(7):
627-630.
besides the duration of surgery can be
shortened (Seisseger et al., 2001).
References
Ginsburg MJ, Ellis GL, Flora LL (1990). Detection
of soft-tissue foreign bodies by plain
radiography,
xerography,
computed
tomography, and ultrasonography. Ann
Emerg Med, 19(6): 701-703.
Halaas GW (2007). Management of Foreign
Bodies in the Skin. Am Fam Physician,
76(5): 683-690.
(Answers to Quiz from page 46)
A1: Dirty multiple open neck wounds.
A2: Embedded foreign bodies on the affected side of the neck.
A3: Endotracheal tube in situ, multiple opaque foreign bodies on the left side of the
neck, mid shaft left clavicle fracture with no subcutaneous emphysema.
A4: Examination under general anaesthesia (EUA), with the help of intraoperative
imaging to localize and remove the scattered foreign bodies.
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