Head injury caused by a nail gun

Accidents in the domestic and professional environment can lead to life-threatening traumata in the ENT region. Here we report a case of a complex trauma induced by a nail gun. A 45 y.o. male patient presented in the trauma center of the department. A nail had accidentally been shot from a nail gun, when he was playing with his son, he reported. In the physical examination, the patient was alert and fully oriented and we found a foreign body that had fixated his concha on the skull. The outer ear canal was obstructed. In the CT scan, the nail was found to have entered into the tympanon with its tip being situated few millimeters in front of the carotid artery.

During the surgical exploration the nail was removed and it was found that the nail entered the outer ear canal from postauricular and penetrated between skin and the bony outer ear canal into the tympanon. A disruption of the ossicular chain was found at the level of the malleus. The tympanic membrane was ruptured, but no further injury was visible. In particular, there was no perilymph leakage visible.

A tympanoplasty was performed and the postoperative bone conduction levels were normal. In the later time course, however, a profound hearing impairment of 60 to 90 dB HL with a minor air-bone gap in the low frequencies developed. Cochlear implantation was offered to the patient.

The case highlights the importance of rules for accident prevention even in the domestic environment.

Publication History

Publication Date:
18 April 2018 (online)