(orofacial impalement)

Penetrating maxillofacial wound, either voluntary or accidental. The name refers to the biblical text (Judges IV, 21) that describes Jael (Yael), wife of Heber the Kenite, killing King Sisera with a tent pole nailed in the face with a hammer.

Anesthetic implications:

-            either difficult or impossible bag and mask ventilation: risk of mobilizing the penetrating object or risk of insufflation of gas through the wound

-      difficult intubation: hematoma, swelling, object entering the airway

-      risk of brisk bleeding if the penetrating object is close to a large vessel (carotid artery, jugular vein, ....)

-        described techniques: nasopharyngeal airway, ketamine, fiberoptic intubation, submental intubation, tracheotomy ...

References :  

-        Cooper JA, Hunter CJ.
Jael’s syndrome: facial impalment.
West J Emerg Med 2013; 14: 158-60.

-         Melillo EP, Hawkins DJ, Lynch L, MacNamara A.
Difficult airway management of a child impaled through the neck. 
Pediatr Anesth 2001; 11: 615-7 

       +  Correspondance Pediatr Anesth 2002; 12: 378-9

-          Bala R, Singh T, Singh R, Kiran S.
Anesthetic management of a wooden parapharyngeal foreign body abcess.
Pediatr Anesth 2007; 17: 904-5

-         Paterson NA.
Management of an unusual pediatric difficult airway using ketamine as a sole agent.
Pediatr Anesth 2008; 18: 785-8

-        Wangyuan Z, Hao H, Qulian G, Yao L, Fei R, Jianquin Y. 
A case of unusual difficult airway because of an intracranial foreign body of bamboo chopstick.
Pediatr Anesth 2009; 19: 921-3

-         Duggan LV, Theron R, Hodgson AL, Kozak FK.
Airway management and definitive care of a toddler following impalement injury by a metal straw.
A&A Case Reports 2016; 7: 143-5.

-        Eskildsen JF, Thorp BD, Baboolal HA.
Airway management of a 3-year-old child with a penetrating oropharyngeal foreign body risking vascular injury. 
A&A Case Reports 2016; 7: 256-9

-        Gluncic V, Lukic A, Hanko E, Lynch J.
Anesthetic management of Jael syndrome with impacted blade in close proximity to the carotid artery: a case report.
A&A Practice 201ç; 12:369-371

Updated: June 2019