Management of the carotid artery following penetrating injuries of the soft palate

Two patterns of impalement injury to the oral cavity: Report of four cases and review of literature

“…Neurological sequelae secondary to carotid artery injury are catastrophic but rare, with only 19 reported cases in the English literature [1,15,16]. A management protocol suggested by Hengerer et al [17] states that these patients should be admitted and observed closely for 48 h, regardless of symptomology.…”

“…A management protocol suggested by Hengerer et al [17] states that these patients should be admitted and observed closely for 48 h, regardless of symptomology. Others contend that 2 days of admission imparts a false sense of security as these patients may experience a lucid interval lasting up to several months after the incident [2,[16][17][18][19]. Consequently, the management of these patients, without clinical indication of neurovascular compromise, has proven to be a controversial subject and a treatment dilemma [16].…”

“…Others contend that 2 days of admission imparts a false sense of security as these patients may experience a lucid interval lasting up to several months after the incident [2,[16][17][18][19]. Consequently, the management of these patients, without clinical indication of neurovascular compromise, has proven to be a controversial subject and a treatment dilemma [16]. A recent review by Brietzke and Jones advocates the use of CT/CT-angiography as first-line measures in the evaluation of oropharyngeal trauma in order to screen for carotid arterial damage [20].…”

Impalement Injuries of the Pediatric Craniofacial Skeleton With Retained Foreign Bodies

“…Angiography evaluates possible internal carotid artery thrombosis or aneurysm. Suskind et al 10 state that selective carotid or cerebral angiography remains the gold standard for evaluating carotid injuries. Magnetic resonance angiography is gaining acceptance and has shown potential for diagnosing these vascular injuries without the risks associated with invasive techniques.…”

“…Obviously, metallic impaling objects preclude the use of magnetic resonance angiography. 10 Impalement injuries have both penetrating and blunt trauma components and therefore have specific consequences. Morbidity may result from direct injury to a vital structure by penetration, damage during removal or extraction of the foreign body, and/or postoperative infection.…”