Herida penetrante del cráneo (síndrome de Jael) por arma blanca / Penetrating wound of the skull (Jael syndrome) by cutting weapon

Objetivo: Describir el tratamiento y la evolución de un paciente con herida penetrante en la base del cráneo.Caso clínico: Paciente masculino de 23 años de edad. Fue atendido en el cuerpo de guardia con herida en región parietoccipital izquierda y con un objeto extraño in situ. En el examen físico neurológico con la escala de Glasgow para el coma obtuvo 15/15, sin signos focales neurológicos. Los estudios radiológicos simples de cráneo evidenciaron que el objeto (una lima) estaba encajado en la base del cráneo. Se le diagnosticó Síndrome de Jael. Se realizó craniectomía parietoccipital izquierda alrededor del sitio de la lesión, apertura dural en cruz con centro en el sitio de entrada del arma blanca. Se extrajo el arma y se le hizo unahemostasia cuidadosa. Se realizó duroplastia con tejido epicraneal y sutura hermética por cada plano desde la profundidad hasta la piel (con puntos mayo). Se indicó tratamiento conantibióticos, analgésicos y anticonvulsivantes. La tomografía axial computarizada posoperatoria mostró defecto óseo poscraniectomía, estructuras encefálicas sin alteraciones,no restos de material metálico, ni desplazamientos de las estructuras de línea media. La evolución posoperatoria fue satisfactoria; y el alta médica, a los 10 días. Mantuvo tratamiento anticonvulsivante por 6 meses. Un año después se mantiene asintomático y seha incorporado a su actividad laboral.Conclusiones: Se logró buena evolución del paciente al realizarle craniectomía alrededor de la lesión, apertura dural en cruz, duroplastia con tejido epicraneal y sutura hermética por cada plano desde la profundidad hasta la piel. Igualmente, el tratamiento con anticonvulsivamente por 6 meses fue efectivo(AU)

Objective: To describe the treatment and evolution of a patient with a penetrating wound at the base of the skull.Clinical case report: A 23-year-old male patient was treated in the emergency department, because of a wound in the left parietooccipital region and with a foreign object in situ. The neurological physical examination with the Glasgow Coma Scale obtained 15/15, with noneurological focal signs. Simple radiological studies of the skull showed that the object (a file) was stuck in the base of the skull. Jael syndrome was diagnosed. Left parietooccipitalcraniectomy was performed around the injury site, dural cross opening with center at the site of the stab entry. The weapon was removed and careful hemostasis was performed.Duroplasty was performed with epicranial tissue and hermetic suture for each plane from depth to skin with May stitches. Treatment with antibiotics, analgesics and anticonvulsantswas indicated. Postoperative computerized axial tomography showed post craniectomy bone defect, unaltered brain structures, no remains of metallic material, or displacements of the midline structures. The postoperative evolution was satisfactory; and the patient hadmedical discharge after 10 days. He maintained anticonvulsant treatment for 6 months. A year later he remains asymptomatic and has joined his work activity.Conclusions: Good evolution of the patient was achieved by performing a craniectomy around the lesion, dural cross opening, duroplasty with epicranial tissue and hermetic suturefor each plane from depth to skin. Similarly, anticonvulsant treatment for 6 months was effective(AU)

Ferimento a faca impactada na face (Síndrome de Jael): relato de caso / Impacted knike injuries of the face (Jael's Syndrome): a case report

Ferimentos a faca cravados na região maxilofacial são raros e pouco relatados na literatura. A importância do conhecimento acerca desses incidentes está no risco de vida ao paciente, especialmente nos casos em que envolvem estruturas cranianas nobres, grandes vasos sanguíneos e obstrução das vias aéreas por hemorragia. Será relatado o caso de um paciente do gênero masculino de 22 anos que foi ferido em uma briga e deu entrada no hospital com uma faca de cozinha cravada na região do nariz e que tinha comunicação com a cavidade bucal...

Impacted knife injuries in the maxillofacial region are uncommon and scarcely reported in the literature. Knowledge regarding knife-inflicted trauma is of paramount importance because these injuries are life-threatening, specially in cases involving vital cranial structures, large blood vessels and airway obstruction caused by hemorrhage. Here we report the case of a 22-year-old male who sustainted a stab wound during a fight and ways admitted to hospital with the blade of a kitchen knife lodged in the lateral region of the nose communicating with the oral cavity...