Volume 2, Issue 1 , Pages 6-8, March 2007
An unusual maxillofacial injury caused by a nail in a child
Article Outline
Summary
Injuries are most serious but preventable major public health problems and frequent causes of morbidity and mortality in young people and children. It has been seen that injuries with nails are usually related to nail guns in the literature. We report a case of an unusually maxillofacial injury caused by nail in a child.
Keywords: Pediatric trauma, Nail, Emergency medicine
1. Introduction
Injuries are most serious but preventable major public health problems and frequent causes of morbidity and mortality in young people and children. Approximately 22 million children are injured in the United States annually, comprising 12% of all trauma patients. Of those, 10% will have facial injuries. With the exception of alveolar injuries (5–65%), those to the nose are the most frequently encountered midfacial injury in children (1–45%) [1].
We report a case of an unusually maxillofacial injury caused by nail in a child and intend to attract attention on pediatric maxillofacial type injuries.
2. Case report
A 4-year-old male child was brought to the Emergency Department with a complaint of a foreign body on his right noise. A detailed history was taken from the patient's family. As the child was running with nails on his hand, he falled down and nails stuck into his nose.
On physical examination, the patient had normal vital signs. He was comfortable. It was determined that the nail penetrated into his right nose wall and soil was found on entrance part. The patient had no signs of airway obstruction. There was no drainage or bleeding from either naris. He had a normal neurological examination. Radiographs and computerized tomography results were obtained to determine the exact location of the nail (Fig. 1, Fig. 2).
Fig. 1.
Anteroposterior and lateral plain skull radiograph showing the nail.
Fig. 2.
Computerized tomography scan demonstrating the exact location of the nail.
After the nail was localized within maxiller bone, the Otolaryngology Department was consulted. The nail was visualized under general anesthesia. The nail was pulled out through its penetration axis and the patient was discharged with complete recovery.
3. Discussion
It has been shown in several studies of maxillofacial trauma that injuries of the maxillofacial region are less common in children than in adults [2]. The nose's central position and anterior projection on the face make it susceptible to traumatic injury. Multiple mechanisms of injury have been reported to cause nasal trauma in children. The most common ones among them were reported to be falls during play and sports, and also child abuses [3]. Several factors contributing to the significantly higher incidence of falls in the younger age group are: (i) with decreasing age, insecurity of motion and balance increases; (ii) awareness of facial appearance and its social importance increases with age. During a fall, older children and adolescents may be more likely to consider shielding their face; (iii) young children are less aware of danger and, therefore, are much less considered in their actions [2]. Similarly, the patient in the case reported here falled down during play and the nail was stuck into his nose. In this injury not only the nose and the maxiller bone was influenced, even though the maxilla is the least frequently injured pediatric facial bone (1.2–20%) [1].
It has been seen that injuries with nails are usually related to nail guns in the literature. The nail guns were designed as powerful industrial tools to drive nails, studs, bolts or staples into various hard surfaces with ease. Since their introduction in residential construction in the late 1950s, many nail gun accidents have been reported in medical literature. Several reports describe injuries involving limbs and fingers, chest, heart, and maxillofacial region. Cases of penetrating craniocerebral injuries caused by a nail gun are fewer and usually associated with increased morbidity and mortality [4]. In this case, although a nail gun was not used, it was determined that a similar injury was occured. His parents denied an injury with a nail gun although they were carefully interrogated. It was rather interesting that the injury occurred due to falling down without a nail gun involved.
It is believed that the goals of treatment should involve prevention of infection, restoration, and return to normal function. Also, the measures to minimize scar and secondary deformity ought to be considered [5]. In this case, no problem was encontured after treatment.
Finally, pediatric trauma may rarely occur in the above-mentioned cases. Especially, parental guide is critical when it comes to control the toys that their children use to play. For example, toys with sharp edges and tools designed for adults like nails, knife, hammers, etc., should be away from children. In addition, clinicians can, and should, be involved with their local, state, and national organizations to help to raise public awareness of pediatric trauma.
References
- . Maxillofacial injuries in the pediatric patient. Oral. Surg. Oral. Med. Oral. Pathol. Oral. Radiol. Endod. 2000;90:126–134
- . Epidemiology of facial trauma in a sample of patients aged 1–18 years. Injury. 2002;33:669–671
- . Nasal trauma in children—surgical treatment. Int. Congr. Ser. 2003;1240:587–589
- . Penetrating craniocerebral injury caused by a pneumatic nail gun: an unsuccessful attempt of suicide. Clin. Neurol. Neurosurg. 2006;108:490–492
- . Management of pediatric maxillofacial trauma. J. Oral. Maxillofac. Surg. 2004;62:102
PII: S1871-4048(06)00092-X
doi:10.1016/j.pedex.2006.10.001
© 2006 Elsevier Ireland Ltd. All rights reserved.
Volume 2, Issue 1 , Pages 6-8, March 2007
