Arrow shot injury to the oro facial regions: Report of two cases

Abstract

Background: Arrow injury is a case of foreign body impaction. It can affect any part of the body. Arrow injury to the head and neck region can be life-threatening. An arrow is a weapon consisting of a thin, straight stick with a sharp point, designed to be shot from a bow. It is one of the oldest tools for hunt and war. Many health practitioners especially in the developed world now regard arrows as extinct. It has been completely replaced by advanced modern weaponry. This is not the case in our environment where the use of arrows with their attendant injury is still relatively common.

Case report: The first case is a 25-year-old farmer, a Nigerian man was seen at the Accident and emergency unit of our centre with an hour history of arrow injury to the right side of the face following the farmer-herder clash. The examination was remarkable for an impacted arrow that was made up iron (impregenation with poisonous substance could not be ascertained) on the right side of the face. He had an urgent plain radiograph of the head and neck which revealed an impacted arrow in the right zygomatic bone. He subsequently had emergency exploration and removal of the arrow. The post-operative period was uneventful. The second case was a 37-year-old man who presented to the accident and emergency department with difficulty breathing following an arrow shot injury to the oral cavity. He was a passenger in a bus that was attacked by armed bandits. On examination, there was an arrow penetrating through the right edge of the tongue, the floor of the mouth to the contralateral submandibular and cervical regions. About 5.0cm of the tail of the arrow could be seen jutting out of the mouth. The exploration was done via a Risdon incision (submandibular incision) on the opposite side of the entry wound (left submandibular) in a retrograde approach. The dissection was advanced into the subcutaneous tissue, platysma, and deep fascial plane to expose the tip of the arrow. The post-operative period was uneventful.

Conclusion: We have illustrated our experience on the cases of arrow injury to the orofacial region. The two cases presented early. There was no pre-hospital attempt at pulling out the arrow. Arrow injury is still common in our community. There is a need for government at all levels to intensify effort on conflict management and resolution.