Removal of a gardening pole penetrating the vicinity of the internal carotid and vertebral arteries

A woman in her 90s was admitted with a gardening pole penetrating her left cheek. She was walking in her garden and fell on the gardening pole (metal cylinder, 9 mm in diameter, 37 cm in length). On arrival, she had normal vital signs, clear consciousness, no paralysis, and no significant bleeding. She had no significant medical history other than osteoporosis. Contrast-enhanced computed tomography imaging showed that the pole had penetrated approximately 14 cm from the left cheek into the left posterior neck and passed between the left internal carotid artery and the left styloid process (left internal carotid artery: arrow, left vertebral artery: white arrowhead, and left styloid process: yellow arrowhead) (Fig. A and B). Although the left transverse process of the atlas (C1) was fractured, her left vertebral artery and internal jugular vein were not injured since the vertebral artery abnormally entered the spinal canal at the caudal portion of C1 and the internal jugular vein was hypoplastic (right vertebral artery [normal]: black arrowhead and right internal jugular vein [normal]: red asterisk) (Fig. A and B). After confirming the absence of vascular damage through an angiogram under general anesthesia, the otolaryngologist removed the pole manually. She was discharged without complications after 1 week.

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