A Case Report on the Asymptomatic First Presentation of a Pencil-Piercing Neck Injury in a 22-Year-Old Boy

IntroductionThe neck is an important part that contains vital structures of vessels, nerves, and aerodigestive organs.Clinically, it's divided into three zones, each containing specific structures, and any penetrating injury is a high risk of multiple serious case scenarios that could be fatal. Case PresentationHere, we report a case of a 22-year-old male who was asymptomatic on the initial visit to the Emergency room except for a slight limitation of jaw movement and tenderness that was attributed to a punch he got from his friend in a fight.No history of a penetrating injury was provided.10 days later, the boy presented with significant neck swelling.CT scan showed a small pencil in zone III of the neck -which is the area between the angel of the mandible and the base of the skull.The patient underwent successful surgery to remove the sharpened object and was discharged on the third day post-op without any neurovascular complications. DiscussionEven though there are common symptoms and signs of penetrating neck injury, such as non-expanding hematoma, subcutaneous or mediastinal air, mild hemoptysis, hematemesis, dysphonia, and dysphagia.There are some asymptomatic penetrating neck injury cases.Notifying a trauma team or a surgeon, if either is available, is necessary for the evaluation of neck injuries.Physical examinations in individuals with neck trauma may not be useful in excluding injuries, so a low bar for requesting additional imaging tests and/or surgical consultation should be considered. ConclusionA penetrating neck injury could have an asymptomatic initial presentation.Imaging and careful examination are necessary in neck trauma cases.