Eight-year-old Xiao Cheng (pseudonym) now appears lively and cheerful during his follow-up at Beijing Children’s Hospital’s ophthalmology and otolaryngology departments, but just months ago, he faced a life-threatening emergency. In February, he fell approximately three meters, impaling a wooden cup holder deep into his right zygomatic bone and scalp.
After six hours of (transferring between hospitals), he arrived at Beijing Children’s Hospital with a complex injury that left experts gravely concerned.
Upon arrival, while Xiao Cheng’s vital signs were stable, CT scans revealed the foreign object had penetrated perilously close to major nerves, blood vessels, and the endocrine center.
Further imaging showed bone fragments and the (foreign body) had invaded the right carotid canal, with a thrombus forming in the internal carotid artery. The risk of uncontrollable hemorrhage, cerebrospinal fluid leakage, or nerve damage during removal was extremely high, while leaving the posed ongoing infection and organ damage risks.
Collaborative Expertise
Facing the intertwined challenges of craniofacial, vascular, and neurological risks, a multi-disciplinary team developed a step-by-step “relay” strategy:
Preventing Catastrophic Bleeding
The next day, Xiao Cheng underwent interventional radiology at 10:00 AM. Anesthesiologist Ma Yangwei induced anesthesia while (interventional radiologists) Yin Jie and Wu Rongchang performed angiography. To prevent potential cavernous sinus bleeding, they strategically placed a coil embolization in the right cavernous sinus, successfully neutralizing the immediate vascular threat.
Carotid Artery Ligation
Immediately following the interventional procedure, the team transferred Xiao Cheng to the adjacent operating room for otolaryngology surgery. Led by Director Wang Shengcai, surgeons Li Yanzhen, Zhang Xuexi, and Liu Zhiyong performed right internal carotid artery ligation to prevent post-removal hemorrhage. A carotid artery occlusion band was pre-positioned as a safety measure, and nasal endoscopy was used to assess and tamponade the nasal cavity with balloon compression.
Craniofacial Surgery
The final phase involved oral and maxillofacial surgery. Director Yu Guoxia and Dr. Li Mingzhe carefully divided the wooden into two segments using a reciprocating saw to minimize traction forces. The first segment, embedded in the skull base, was gently loosened and extracted with controlled bleeding, followed by the successful removal of the subcutaneous second segment.
Post-Surgery Recovery and Follow-Up
After a complex three-stage operation spanning multiple departments, Xiao Cheng recovered steadily. While mild right esotropia (inward eye deviation) persisted during follow-up, neurosurgical and ophthalmological evaluations confirmed no major neurological deficits or vision loss. The multi-disciplinary team’s meticulous planning—combining interventional radiology, vascular surgery, and craniofacial expertise—was credited with overcoming the high-risk scenario.
Challenges of Penetrating Craniofacial Injuries
Dr. Wang Shengcai emphasized the rarity of such injuries in children, noting the critical need for rapid multi-disciplinary collaboration. “The proximity to the carotid artery and skull base required precise staging: embolization first to control vascular risks, followed by surgical removal under strict hemostatic control,” he explained. Director Yu Guoxia added that preserving neural function while removing fragmented demanded microsurgical precision to avoid secondary trauma.
This case highlights the importance of specialized pediatric trauma centers in managing complex injuries, where coordinated expertise across departments can turn life-threatening situations into stories of recovery. As Xiao Cheng continues his rehabilitation, his journey serves as a testament to the power of interdisciplinary medicine in pediatric critical care.
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