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No. 2 in zone 2: a case report of penetrating neck trauma in a child
  1. Rami Jason Bustami1,
  2. Alex Moses1,
  3. Ahmad Saeed Imam1,
  4. Ross Morgan2
  1. 1College of Medicine, University of Central Florida, Orlando, Florida, USA
  2. 2Pediatric Surgery, Arnold Palmer Hospital for Children, Orlando, Florida, USA
  1. Correspondence to Mr Rami Jason Bustami, College of Medicine, University of Central Florida, Orlando, FL 32837, USA; rjbustami{at}

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Penetrating neck trauma is common in adults but is rare in the pediatric population. Reports on penetrating neck trauma in the pediatric population is sparse. We describe the case of a 9-year-old boy presenting with a pencil penetrating the neck, discuss management, and review the literature.

Case presentation

A 9-year-old boy with no medical history presented to the trauma bay by emergency medical services (EMS) approximately 45 min after falling onto a Number 2 (No. 2) pencil which penetrated the left preauricular space. The pencil was stabilized with gauze and tape by EMS prior to arrival. In the trauma bay, the patient denied loss of consciousness, profuse bleeding, headache, dizziness, lightheadedness.

Physical examination

Vital signs were stable. The patient was lying supine in an EMS stretcher with the dull end of a No. 2 pencil protruding from the left preauricular space, pointing caudally and posteriorly. Pencil was stabilized in gauze and tape. No active bleeding was present. Patient was awake, alert, and oriented. The patient had full range of motion of the mandible.

Workup and treatment

Initial evaluation was performed with CT without contrast (figure 1). On poor visualization of the associated vasculature within the carotid sheath, a CT with contrast was performed. The radiologist reported no rupture …

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