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Combined external and endoscopic transnasal approach with use of a diamond burr in the removal of a fishing harpoon hook traversing bilateral sphenoid sinuses in a 22-year-old man
  1. Jan Alexeis Lacuata,
  2. Agnes Tirona - Remulla,
  3. Arsenio Claro Cabungcal and
  4. Romiena Mae Santos
  1. Department of Otorhinolaryngology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
  1. Correspondence to Dr Jan Alexeis Lacuata; jclacuata{at}


A 22-year old construction worker was shot with a fishing harpoon gun on the left side of his face. He consulted at the emergency room 12 days postinjury, stable but with blurring of vision on the right. The shaft of the harpoon was protruding at the left preauricular area; the tip was neither visible nor palpable. Craniofacial CT scan and skull anteroposterolateral radiographs revealed the tip of the harpoon to be at the right orbital apex. A hook attached 1 cm from the tip was lodged in the sphenoid sinus. The hook was dismantled from the shaft via a combined external and endoscopic transnasal approach, enabling the shaft to be gently pulled. The hook, together with the tip, were removed endoscopically. The patient’s visual acuity improved. He was discharged after 2 days on oral antibiotics with no deficits on follow-up.

  • trauma
  • otolaryngology / ENT
  • head and neck surgery

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  • Correction notice This article has been corrected since it was published online. The article title has been corrected to "…the traversing the bilateral posterior ethmoids".

  • Contributors JAL: conceptualisation, review of literature, data curation, documentation, writing–original draft, writing–review and editing, writing–final manuscript; ATR, ACC and RMS: conceptualisation, review of literature, data curation, supervision, documentation, writing–original draft, writing–review and editing.

  • 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.

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