An Unusual Facial Impalement Injury in a 75-Year-Old Male

A 75-year-old male presented to the emergency department (ED) following a fall from his bicycle. The patient fell face-first onto the handlebars, with the brake handle impaling his left upper lip. Paramedics were able to detach the handle from the bicycle and transport him to the ED. He denied loss of consciousness, neck pain, dental pain, or other injuries. Examination revealed the brake handle protruding through his upper lip just inferior to the nasal labial fold (Figure, panel A). No other intraoral trauma was noted, and bleeding was minimal. The ED physician carefully extracted the brake handle from the wound, revealing a 2.5 cm linear laceration. Regional anesthesia was accomplished using an infraorbital nerve block (1:1 mixture of lidocaine: bupivicaine). The wound was irrigated with sterile saline, and repaired using four subcutaneous 4.0 absorbable sutures followed by 6-6.0 nylon skin sutures Figure 1. A 75-year-old male with bicycle brake handle impaled into his left upper lip (panel A), and following removal of the brake handle and complex suture repair of the resulting laceration (panel B).