Penetrating transoral cranial injury by a chopstick through the jugular foramen: Report of a case

A 57-year-old man attempted to commit suicide by thrusting a chopstick into his throat during a meal, resulting in penetrating injury into the cranium. Computed tomography revealed that the chopstick had penetrated the soft palate and passed through the jugular foramen to the cerebellum, damaging the internal jugular vein. The chopstick fractured in the lateral pharyngeal space and was impossible to observe directly from the oral cavity, requiring surgical cooperation with neurosurgeons to remove the object under general anesthesia. After one end of the chopstick body was identified in the deep portion of the styloid prominence, an approach was made from the neck to prevent hemorrhage and gas embolism in the affected internal jugular vein. The other end of the chopstick was identified near the jugular foramen and it was removed through the neck via occipital craniotomy. Post-operative management included sedation and artificial ventilation to manage brain contusion and edema and intracranial inflammation. The patient was gradually recovered and transferred to a general ward 4 weeks after the surgery. After 4 years, the patient retains clear mentation, but remains hospitalized in a rehabilitation hospital because of persistent quadriplegia. (C) 2011 Asian Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.