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Unusual presentation of more common disease/injury
CASE REPORT
On a knife-edge: clinical uncertainty with an extensive knife blade in situ in the craniofacial region
  1. Dairui Dai1,
  2. Silke Meyer2,
  3. Lars Christian Kaltheuner2,
  4. Frank Plani3
  1. 1Department of Medicine, University College London Medical School, London, UK
  2. 2Department of Medicine, Universitatsmedizin Greifswald, Greifswald, Germany
  3. 3Trauma Department, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
  1. Correspondence to Dr. Dairui Dai, daid1218{at}gmail.com

Summary

A 25-year-old man presented to the trauma department following a penetrating stab wound to his left infraorbital margin with retained knife blade causing superoposterior displacement of the globe. Plain skull X-ray revealed an extensive retained blade with subsequent CT imaging revealing the tip of the blade had reached the right styloid process with no neurovascular compromise. Initial concern was primarily for the left eye leading to ophthalmology being the first specialty requested to review the patient. However, once the extent of the injury was established, ophthalmology requested further review from maxillofacial, ENT and neurosurgery. This resulted in an 84 hours wait between the initial injury and the removal of the knife blade. Incredibly, the patient had no initial sequelae from such an extensive injury and had an unremarkable recovery with no further complications aside from a laceration to the left inferior rectus muscle that was conservatively managed.

  • emergency medicine
  • trauma
  • ophthalmology
  • oral and maxillofacial surgery

https://doi.org/10.1136/bcr-2018-226054

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    Footnotes

    • DD and SM contributed equally.

    • Contributors DD: saw the patient on admission to trauma and followed-up the patient’s subsequent care. Initiated the idea for doing this case report and selected the journal. DD: the initial plan of the write up and performed the literature review. Processed the X-ray imaging. Wrote the final version of the case report and reviewed the case report at all stages. SM: followed-up the patient’s subsequent care. Recorded all the patient notes and collected the images. Wrote the first draft of the case report and amendments to subsequent sections. Involved in the review of the case report at all stages. LCK: followed-up the patient’s subsequent care. Processed the CT imaging and produced the 3D reconstruction from the CT slices. Gained consent from the patient and communicated with the patient to attain the patient perspective. Involved in the review of the case report at all stages. FP: gave the initial permission to follow this patient under the trauma team and to write up a case report. Gave guidance as to the process of selecting a journal and writing up a case report. Involved in the review of the case report at all stages.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.