CMS

Shristi Gurung, a 11 year old child from Butwal; was brought to College of Medical Sciences, Bharatpur with a wooden stick penetrating thro’ and thro’ into the neck. The wooden stick was a branch of a tree entering from the left side of neck at the level of hyoid bone and coming out from the right preauricular region just anterior to the tragus. A history of fall from a tree about 8 feet high was revealed.

 
                 Before                                                 After
There was no active bleeding and the child was conscious. A CT scan was done immediately and it showed a penetrating foreign body with no obvious vascular involvement. The child was taken to the operation theatre and a tracheostomy was done under local anaesthesia. Then the oropharynx could be examined and it showed the foreign body passing thro’ it. A midline lip-splitting incision was given and a midline mandibulotomy was performed. Then base of tongue was incised vertically to gain access into the oropharynx. After adequate exposure the wooden stick was cut with scissors and the two parts removed separately. The wound was then closed in multiple layers.

Post-operative period was uneventful. Tracheostomy was removed on 13th postoperative day and the N-G tube on 18th postoperative day. The child has now gone home with a smile on her face. A life has thus been saved.