Jael's syndrome: Case report and literature review

Introduction and importance

Jael's syndrome, an intentional injury caused by a knife in the face or skull is a rare encounter in clinical and forensic practice, rarely involving an impacted knife. Clinical and radiographic diagnosis is essential to identify severity of injury and location of the retained knife. To the best of our knowledge, this is the first reported novel case of Jael's syndrome in Tanzania.

Case presentation

We present the case of a 31-year old man admitted at Muhimbili National Hospital following an impacted knife. The stab wound extended to the medial wall of left orbit and ended just before the optic foramen associated with vitreous hemorrhage and the retained knife caused superoposterior displacement of the globe. Multidisciplinary management was instituted including prompt evaluation, imaging and surgical removal of the knife under general anesthesia.

Clinical discussion

Plain skull X-ray revealed an extensive retained blade and computerized tomography (CT) showed the tip of the blade adjacent to the right styloid process with no neurovascular compromise. Initial concern was the left eye that was reported to be viable by ophthalmologists. Incredibly, the patient had no initial sequelae from such an extensive injury and had unremarkable recovery with no complications apart from the wound to left inferior rectus muscle that was conservatively managed. Simple withdrawal of the retained knife was successful.

Conclusion

Craniofacial retained knives are rare. Thorough prompt initial evaluation and intervention is vital since improper management can be devastating.

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Impacted knife at the craniofacial region is a very rare encounter.

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Clinical and radiographic diagnosis is essential to identify extent of damage to critical structures.

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Complications such as diplopia, intracranial hemorrhage and acute cerebrospinal fluid leakage have been reported.

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Multidisciplinary management has to be instituted when retained foreign bodies are encountered.

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Simple surgical removal along the path of insertion of retained foreign body seems safe and effective.

Penetrating Foreign Bodies in Head and Neck Trauma: A Surgical Challenge

Penetrating foreign bodies of different origins in the head and neck are rare and potentially dangerous injuries, which might pose problems for their detection, primary care, and final treatment. Depending on the severity of the underlying trauma, some injuries present a higher risk for the presence of foreign bodies. Minor wounds, including common lacerations, are likely to be contaminated with loose gravel debris or dental fragments, and need to be distinguished from severe wounds caused by impalement, shootings, stabbings, and explosions. Blast injuries resulting from terror attacks are challenging recent therapeutic concepts. Even though these injury patterns are uncommon, they carry the risk of impacted objects with dramatic consequences. Despite improving medical imaging techniques, detection remains a challenge as it is dependent on the material of the foreign body, the affected anatomical site, and the injury severity. Therefore, a detailed history of the circumstances leading to trauma is essential when foreign objects are not visible during clinical examination. Precise detection of the foreign body, its anatomical position, and the affected surrounding structures are vital, especially for impalement injuries of the head and neck area. Therefore, an interdisciplinary planning approach is essential prior to removal of the foreign object. Finally, tension-free anatomical adaptation of the corresponding structures is crucial for maintaining and restoring aesthetic and function. Here, we give an overview of the diagnosis and treatment of cases of foreign body injuries encountered in our department.