Removal of a gardening pole penetrating the vicinity of the internal carotid and vertebral arteries

Article information

Arch Craniofac Surg. 2024;25(6):309-310

Publication date (electronic) : 2024 December 20

doi : https://doi.org/10.7181/acfs.2024.00458

Nanami Fujita¹, Kensuke Shimada^,2,3,4, Akimasa Kajino⁵, Ryota Inokuchi⁶, Shuichi Kawada⁷, Shunsuke Ishitsuka¹, Masato Yamada⁸

¹Department of Anesthesiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan

²Transrational Research Promotion and Education Center, Tsukuba Clinical Research and Development Organization, University of Tsukuba, Tsukuba, Japan

³Department of Anesthesiology, University of Tsukuba Hospital, Tsukuba, Japan

⁴Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Japan

⁵Department of Head and Neck Surgery, Saitama Prefectural Cancer Center, Kita-Adachi, Japan

⁶Department of Health Services Research, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan

⁷Department of Radiology, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan

⁸Department of Otorhinolaryngology, Head and Neck Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan

Correspondence: Kensuke Shimada Transrational Research Promotion and Education Center, Tsukuba Clinical Research and Development Organization, University of Tsukuba Hospital, 2-1-1 Amakubo, Tsukuba, Ibaraki 305-8576, Japan E-mail: kensukeshimada.s@gmail.com

Received 2024 August 27; Revised 2024 September 21; Accepted 2024 December 9.

A woman in her 90s was admitted with a gardening pole penetrating her left cheek. She was walking in her garden and fell on the gardening pole (metal cylinder, 9 mm in diameter, 37 cm in length). On arrival, she had normal vital signs, clear consciousness, no paralysis, and no significant bleeding. She had no significant medical history other than osteoporosis. Contrast-enhanced computed tomography imaging showed that the pole had penetrated approximately 14 cm from the left cheek into the left posterior neck and passed between the left internal carotid artery and the left styloid process (left internal carotid artery: arrow, left vertebral artery: white arrowhead, and left styloid process: yellow arrowhead) (Fig. A and B). Although the left transverse process of the atlas (C1) was fractured, her left vertebral artery and internal jugular vein were not injured since the vertebral artery abnormally entered the spinal canal at the caudal portion of C1 and the internal jugular vein was hypoplastic (right vertebral artery [normal]: black arrowhead and right internal jugular vein [normal]: red asterisk) (Fig. A and B). After confirming the absence of vascular damage through an angiogram under general anesthesia, the otolaryngologist removed the pole manually. She was discharged without complications after 1 week.

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