Penetrating knife injury to the face and skull

Case contributed by Anthony Zhewei Liu

Presentation

Alleged assault with stab wound to the face.

Patient Data

Age: 55 years
Gender: Male

Traumatic penetrating knife injury to left face and skull base with significant metallic artefacts.

The knife enters the left cheek with associated hemorrhage and soft tissue swelling, and it passes inferior to the zygomatic arch and through the left mandibular coronoid process resulting in a comminuted fracture of the coronoid process.

The knife then passes the left lateral pterygoid plate and fractures it. It then passes through the left paramedian inferior clivus into the foramen magnum, with a resultant skull base fracture.

Tip of the knife is just to the right of midline in the anterior aspect of the posterior fossa, likely within the pretontine or cervicomedullary cistern. Knife tip entry into the parenchyma of the adjacent brainstem is not able to be assessed due to the artefact.

No active extravasation of contrast or pseudoaneurysm on the initial DSA of the left vertebral artery and left internal carotid artery.

Repeat DSA after knife removal shows unchanged appearances of the internal carotid artery.

Case Discussion

The patient is a victim of alleged assault with penetrating knife injury through the clivus and into subdural space, and narrowly misses the brainstem and the basilar artery.

The patient was discharged home and reports no complications or significant neurological sequelae on follow-up appointments.

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