- 期刊
Jael's Syndrome: Management of Facial Impalement Injuries-2 Case Reports and A Literature Review
Jael's Syndrome：顏面穿刺傷處理－兩例病例報告及文獻回顧
摘要
Jael's Syndrome, which is quite rare in Taiwan, is potentially life-threatening. This type of trauma presents a challenge to doctors managing the cases, as it may potentially be associated with problems involving the airways, vasculature, eyes, ducts, and neurological function. We present two cases of facial penetration wounds admitted to Taipei Tzu Chi hospital emergency room with retained foreign bodies on their face. The first case was accidentally penetrated by a metal stick on patient's mid-face. The wound extended from right maxillary bone into right maxillary sinus, and then into skull base of sphenoid bone. The second case was injured by toy gun shot on right temporal area with a retained bullet. Fortunately, there were no initial sequalae from such an extensive injury in these two patients, and at this moment, there are no further complications after multidiscipline care. Multidisciplinary management should be considered, including prompt evaluation, imaging diagnosis, surgical removal of foreign bodies, immediate repair of damaged tissue, and possibly reconstruction at a later time. In primary care, the priority is to stabilize the patient's vital signs, secure the airway (through intubation or tracheostomy, if necessary), and manage bleeding to maintain hemodynamic stability. Choice of radiological diagnosis methods might also be important. Inappropriate radiological assessment may increase the possibility of false-negative findings. Appropriate planning for the removal of a foreign body provides better outcomes, not only functionally but also aesthetically, for the patient.
並列摘要
Jael's Syndrome是一種可能會危及生命的創傷，且在台灣非常罕見。由於這類型的創傷可能與呼吸道、血管、眼科、腺體及神經系統等多科別問題有關，成為缺乏處理這些類型病例經驗的醫生之挑戰。本文介紹兩例因顏面部穿刺傷至台北慈濟醫院急診室並會診口腔顎面外科的病例。第一個案例是一根斷裂的金屬片意外刺入患者中顏面部，經由上顎骨進入到右上顎竇，然後延伸至顱底蝶骨基部。第二例患者為玩具槍槍擊傷，並且子彈留置於病患右側顳區。幸運的是，這兩名患者雖有嚴重的損傷，但在跨科別診斷及治療照護下並沒有出現嚴重的後遺症及併發症。這類型的創傷應考慮跨科別的治療，包括及時評估、影像學檢查和手術移除外來物並修補重建。其中首要任務是穩定患者的生命體徵、維持呼吸道（插管、氣管切開術）並控制出血以維持充足的體液。使用何種放射檢查工具的選擇亦很重要。此外，重要的是適當術前規劃，方能為患者提供不僅功能恢復而且美觀的最佳結果。