Suzamma Joy Joseph, Kahairi Abdullah, Eshamsol Kamar and Mohanarasan Ratanam
Penetrating neck injuries represent approximately 5% to 10% of all trauma cases that present to the emergency department. These cases may result in significant mortality due to the presence of many vital structures within the neck which lack skeletal protection anteriorly. In this case, we report a case of a gentleman who had a spear penetrate the anterior of his neck. He subsequently underwent surgical removal of the spear. A vertical incision along the anterior border of the sternocleidomastoid was made to provide proper surgical exposure to the site of injury. Layers of the muscles along the foreign body were separated using the artery forceps and by digital manipulation until the end of the hook was identified. The skin incision was extended to obtain a wider surgical exposure and to make sure the whole length of the spear was exposed. Finally, a spear with 3 hooks was identified lying just lateral to the tendon and posterior belly of the digastric muscle and just below the facial vein with the tip of the spear blocked by a dense fibrous tissue just medial to the anterior border of the sternomastoid muscle, thus preventing it from damaging the carotid sheath which contained the carotid artery and internal jugular vein. The spear was removed successfully. In conclusion, despite not having skeletal support anteriorly, the muscles and fascia in the anterior of the neck is important in protecting vital structures in the neck apart from its' primary function of mobility.
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