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in an accidental dispute, a 29-year-old man named pu suffered incredible injuries: a chopstick was inserted from his left ear, penetrated the upper and lower walls of the external auditory canal, and passed through the side wall of the neck directly to the oropharynx. the incident occurred on september 25. because the local hospital could not handle such a serious injury, pu was urgently transferred to the emergency department of the ninth people's hospital affiliated to shanghai jiao tong university school of medicine (hereinafter referred to as "shanghai ninth hospital").

at that time, pu was in a drunken state and was not accompanied by his family. the doctor at the emergency otolaryngology and head and neck surgery department of shanghai ninth hospital immediately performed anti-infective treatment and quickly reported the condition to shi runjie, the chief physician of the department.

pu's ct vascular imaging showed that the chopsticks inserted into the face penetrated the left external ear, passed through the left parotid gland to the left parapharynx, and were placed exactly in the main artery of the neck blood vessels - the internal jugular artery and vein, and between the blood vessels. only millimeters apart.

the chopsticks are inserted from the patient's left ear, penetrate the upper and lower walls of the external auditory canal, and pass through the side wall of the neck directly to the oropharynx. photo courtesy of shanghai ninth people's hospital

shi runjie said that it is this millimeter gap that provides the patient with a glimmer of hope. no obvious damage or rupture has been found in the important blood vessels in the patient's neck.

after admission and completion of relevant examinations, the hospital's department of otolaryngology, head and neck surgery, department of oral, craniofacial and maxillofacial surgery, and department of anesthesiology conducted a multidisciplinary consultation. considering that the foreign body is located deep, close to the base of the skull, and surrounded by important blood vessels and nerves in the neck, forcibly removing the foreign body from outside the body may cause massive bleeding during the operation, which cannot be treated in time, and the surgical risk is extremely high. because the inserted chopsticks are close to the skull base and major blood vessels, a larger surgical incision may be required and important tissue structures such as the mandible may need to be cut off if performed conventionally.

after careful analysis, shi runjie decided to add endoscopic navigation-assisted technology on the basis of the external cervical surgical approach. this can reduce the surgical incision, expose the chopsticks under the endoscope, and separate important surrounding blood vessels and nerve tissue to avoid further damage.

with close cooperation from the department of anesthesiology, shi runjie performed the surgery, and two other doctors, yan xiaojun and chen bin, cooperated to accurately expose the chopstick foreign body between the important blood vessels and nerves at the base of the skull under endoscopic navigation according to the scheduled surgical plan, and fully separated and released the incarcerated foreign matter inside. chopsticks, then remove the foreign body from the chopsticks and treat the external auditory canal wound under an otoscope.

the operation went smoothly. important blood vessels, nerves, and muscle tissue were not cut off during the operation, and the amount of bleeding was minimal. afterwards, the doctor will help the patient perform neck skin tension reduction and cosmetic sutures to reduce scarring as much as possible.

the surgical team worked closely together and a series of surgical procedures were completed quickly, lasting only about 30 minutes. after the operation, pu's condition is stable and he is recovering well. he is now out of danger and has entered the recovery period and will be discharged soon.

shi runjie reminded that when suffering from trauma, you must first stay calm and use clean water to rinse the wound to remove surface dirt and foreign matter to avoid infection. if disinfectants such as alcohol and iodophor are available, you can disinfect the area around the wound, but avoid direct contact with serious open wounds. if there are foreign objects such as glass, metal, etc. in the wound, keep it stable and apply local brakes to prevent the foreign object from further damaging the surrounding tissue. do not forcefully pull it out to prevent the foreign object from damaging the blood vessels, exposing the rupture of the blood vessels and causing life-threatening bleeding. it is dangerous. at the same time, pay attention to compression and hemostasis. if you encounter severe head and face trauma and experience symptoms such as coma, nausea and vomiting, it may be accompanied by the risk of intracranial injury. pay attention to protecting the wound and call the emergency number immediately for medical treatment.

shi runjie specially reminded that drinking should be moderate in life to avoid accidental injuries caused by drunken disputes.