BURIED IN SILENCE: A NAIL, A CHILD, AND A RACE AGAINST TIME” : A MULTIDISCIPLINARY TRIUMPH IN A PAEDIATRIC FACIAL IMPALEMENT AND AIRWAY CRISIS. ektasingh@kgmcindia.edu

 

BURIED IN SILENCE: A NAIL, A CHILD, AND A RACE AGAINST TIME” : A MULTIDISCIPLINARY TRIUMPH IN A PAEDIATRIC FACIAL IMPALEMENT AND AIRWAY CRISIS.

3

India

Poster with Discussion

Penetrating facial injuries in children are uncommon but potentially life-threatening, particularly when associated with delayed presentation and airway compromise. Rural settings often face challenges related to limited access to specialized trauma care. Early identification and a coordinated multidisciplinary approach are crucial for favorable outcomes.

A 6-year-old girl was brought to the Emergency Department of a Level 1 trauma center 11 hours post-injury, with facial and neck swelling, nasal bleeding, and inability to speak. Examination revealed a restricted mouth opening and an impacted metallic nail at the floor of the mouth (left side). The mechanism of injury was unknown. Her vital signs on arrival were stable (HR: 117/min, BP: 105/56 mmHg, SpO₂: 96% on room air), but her airway was threatened due to progressive swelling.

A multidisciplinary team including trauma surgery, ENT, neurosurgery, and OMFS was activated. A surgical tracheostomy was performed to secure the airway, followed by successful removal of the embedded foreign body in the operating room. Postoperative care in the pediatric ICU ensured uneventful recovery. The child was discharged on the 18th post-injury day with no complications.

This case illustrates the critical role of early airway management and coordinated multidisciplinary care in pediatric penetrating facial trauma. Delayed referral from a rural area increased the complexity, but timely intervention led to a positive outcome. Strengthening rural trauma referral systems and raising awareness about atypical pediatric injuries can significantly improve outcomes in similar cases.