Pediatric Neck Impalement Injuries: A Report of Two Cases and Review of the Literature.

Penetrating neck impalement injuries in children are rare but potentially life-threatening. We present two cases to illustrate the clinical spectrum of this injury pattern and reinforce key management principles. Case 1 was a 13-year-old female patient who sustained a wooden stick impalement to the right neck during a sledding accident. She was hemodynamically stable with a Glasgow Coma Scale (GCS) score of 15 and no neurological deficits. Computed tomography (CT) angiography showed a 2.5 cm soft tissue laceration with no vascular or aerodigestive injury. Case 2 was a 17-year-old female patient struck by a wire projectile from a lawnmower, presenting with immediate left upper extremity paresthesia but intact motor function and airway. CT confirmed a metallic foreign body traversing the spinal canal from T1-T2 to T2-T3 without vascular or aerodigestive injury. Both patients underwent operative removal of a foreign body under general anesthesia. Case 1 required wound irrigation and suture repair; she was discharged on oral antibiotics without complications. Case 2 underwent wire extraction with intraoperative neurophysiological monitoring and received targeted antibiotic prophylaxis given agricultural contamination. She was discharged neurologically intact with a cervical collar and orthopedic follow-up. These cases reinforce that pediatric neck impalement demands CT angiography prior to removal (if feasible), operative extraction in a controlled surgical setting, and vigilance for delayed complications, including carotid thrombosis, regardless of how benign the initial presentation appears.