A reverse nailed frontal sinus and craniofacial injury: Case report and literature review

Impalement injuries are uncommon in the head region. It can be accidental, following acts of violence, exorcism, or self-inflicted. Various impaling objects, including nails, have been reported. An infrequent presentation is accidental impalement of the frontal sinus with a nail in a reverse pattern, as demonstrated in our patient. Herein, we present possible mechanisms underlying this rare presentation, highlighting our management decision-making process and appraising the available evidence on the nuanced surgical approach and management. In addition, we reviewed the reported cases of frontal sinus impalement injuries. A 50-year-old male teacher presented to our emergency department with a nail stuck in his forehead while separating a fight between two students. Clinical and radiological investigations were in keeping with frontal sinus nail impingement injury, with a nail head embedded within the sinus. The patient subsequently underwent wound exploration, nail extraction, sinus mucosectomy, and wound closure. The patient was discharged under excellent conditions and is currently being followed up. Frontal sinus nail impalement injury is a rare presentation of craniofacial injury and poses a significant risk due to its proximity to cerebrovascular structures. Adequate evaluation and timely management are recommended to avoid long-term complications. Owing to the heterogeneous presentation of impaled frontal sinus injuries, the surgical decision process should be on a patient-to-patient basis.