Jael’s Syndrome: Facial Impalement
A 25-year-old male was working with braided cable under tension at a local construction site when the cable, approximately 2 inches in diameter, snapped without warning and perforated his right cheek, penetrating his right temporal and right parietal lobe. After shortening the cable to 1.5 feet at the construction site, emergency medical services brought the patient to our Level I trauma center. He was transported wearing a cervical spine collar in the sitting position. On arrival, he was awake and alert, unable to speak, and mildly agitated. His initial vital signs were a blood pressure of 159/67 mmHg, heart rate of 54 beats per minute, respiratory rate of 18 breaths per minute, and a pulse oximetry reading of 97% on 15 liters of oxygen. The remainder of his primary and secondary surveys revealed no further injuries.\nBecause of the position of the cable through his jaw and upward into his brain, the patient was unable to open his mouth more than two centimeters. In the trauma bay he became more agitated and began to pull at the cable that protruded 1.5 feet outside of his mouth. We decided to sedate and intubate him to facilitate further evaluation and treatment of his injuries. After 30 mg of etomidate and 100 mg of succinylcholine administered intravenously, blood and construction site debris was suctioned from his oropharynx, and he was intubated using the GlideScope Portable GVL and a 7.5 endotracheal tube on the first attempt.\nThe patient was taken for an IV-contrasted computed tomography of his brain, face, and neck to assess vascular injury and define the extent of damage ().\nThe patient was taken to the operating room for cable removal, neck exploration, facial nerve exploration, right temporal craniotomy, and tracheostomy. He was found to have a cranial nerve XII paralysis, right temporal and parietal lobe traumatic brain injury and intraparenchymal hemorrhage, intraventricular hemorrhage, right cochlea damage, and some general soft tissue damage. On post-operative day 3, he was transferred to the floor on a liquid diet. On post-operative day 7 he was diagnosed with bacterial meningitis after developing a headache, fever, and neck rigidity. On post-operative day 13 he was discharged on oral antibiotics to a rehabilitation facility.