a 6yearold male was brought to our emergency department having sustained an accidental penetrating injury to zone 1 of the neck with a sickle . on examination , there was a foreign body sickle ( fig .
1 ) with its wooden handle as an entry point at the right submandibular region with no active bleeding and without evidence of vascular or neurological injuries .
the sickle had serrated part on its concave surface and blunt part on its curvature .
2 . what is the superior limit of foreign body piercing the neck in this patient ?
penetrating neck injury can be life threatening because of the increased risk of injury to the vital structures such as blood vessels , airway , cervical spines , and nerves which are present in such a small confined area 1 .
the foreign body may be providing tamponade effect on a major blood vessel so it should not be blindly pulled out until radiological evaluation 2 .
our patient initially has undergone plain xray of the neck as a means of costeffective investigation . but from xray alone , it was not possible to find the accurate information regarding the relation of foreign body with the adjacent vital structures .
computed tomography scan can be helpful to know the extent of the injury sustained by the patient with penetration of neck with sharp objects such as sickle , knife , broken glasses , metallic and wooden foreign bodies . in this case
, the computed tomography showed the metallic foreign body penetrating the soft tissue of neck on right side reaching the opposite side orbit .
intraoperatively , the foreign body was found to be penetrated to floor of mouth , involving dorsum of tongue and soft palate , then entered into left nasal cavity , piercing the middle turbinate , and finally entered into left orbital cavity lying posterior , that is , very close to the orbital apex ( fig . 2 , 3 , 4 ) .
coronal view of ct scan showing the entry point and the extent of foreign body .
axial view of ct scan showing metallic foreign body in left orbit . correlating the radiological and clinical finding ,
although xray plain film is a costeffective investigation method in the case of metallic foreign body penetrating the neck , one should not rely alone on it , as it can not reveal status of neurovascular structures lying adjacent to foreign body in an anatomically important area such as head and neck region .
ct scan is a definitive imaging technique which yields important information and makes interpretation easy .
so , it must be taken before planning the removal of foreign body in operation theater .
 key clinical messagect scan is the most important investigation in patients with penetrating neck injury in which it can show the extent of internal injury which may be overlooked . without ct scan being performed , one should not try to remove foreign body by just pulling blindly , as it can injure vital structures . 
Introduction
Discussion and Outcome
Take Home Message
Conflict of Interest
Authorship