www.thelancet.com Vol 375 January 23, 2010 317
Clinical Picture
Impaled head
Martin Missmann,ThomasTauscher, Siegfried Jank, Frank Kloss, Robert Gassner
Although case reports of trauma describe single events
only, they can contain very useful scientific information
for applied surgery. The portrait of Gregor Baci from the
collection of Archduke Ferdinand II of Austria (figure A)
provokes the question: is the legend that Baci survived a
piercing injury with a lance only a myth, or does medical
fact indicate that such severe impalement of the head and
neck can be survived? We were able to provide the answer,
when a similar case of impalement presented to us. The
patient, a craftsman, was injured when a metal bar fell
from the ceiling of a church with an altitude of about 14 m,
impaling his head in an anterior-posterior direction
(figure B). The track of the metal bar followed a
mediocaudal line that was near parallel to the Frankfort
horizontal line. The bar entered at the anterior wall of the
maxillary sinus, passed the pterygopalatine and infratemporal
fossa, and exited at a point mediocaudal to the
mastoid process. The patient had to undergo surgical
treatment twice, and had a year of episodes with headache
and moderate diplopia, but now, about 5 years after the
accident, the patient does not show any related clinical
symptoms. This case shows that even severe penetrating
traumas of the head and neck can be survived without
sequelae of serious physiological dysfunction. Moreover,
some of the penetrating objects are in size and shape
similar to surgical tools, and therefore such pathways to
deeper structures—eg, the infratemporal fossa—might
be feasible for endoscopic skull-base surgery.
Lancet 2010; 375: 317
Department of
Cranio-Maxillofacial and Oral
Surgery (M Missmann MD,
S Jank MD, F Kloss MD,
Prof R Gassner MD) and
Department of Vascular
Surgery (TTauscher MD),
University Hospital of
Innsbruck, Innsbruck, Austria
Correspondenceto:
ProfRobertGassner,Department
ofCranio-Maxillofacial andOral
Surgery,University Hospital of
Innsbruck,Innsbruck6020,Austria
robert.gassner@uki.at
A B
Figure: Impaled head
(A) Portrait of Hungarian hussar Gregor Baci, Ambras castle, Innsbruck, Austria (16th century). Reproduced with permission from Kunsthistorisches Museum mit MVK
und ÖTM. (B) CT scan of patient (posterior-anterior scout view, approximately semi-lateral view of the head, positive).