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December 18, 2011

Carpenter Shoots Himself in the Neck with Nail Gun

According to Boston News, in early December 2011, a carpenter accidentally discharged a nail gun and embedded a 3.5 inch nail in the bottom of his neck. Based on the CT scan included here, it appears the nail entered the neck dead center given the clear appearance of the windpipe.

Based on the location, the anatomic sequence of nail piercing is as follows:

Skin --> Thyroid Gland --> Trachea --> Esophagus Back Wall --> Cervical Vertebral Body

The damage to skin, thyroid, and trachea is not a big deal... In fact, one can consider this a mini-tracheostomy. Minimal bleeding would be expected.

However, the hole between the trachea and esophagus is another matter which may heal well... or not. The esophagus is the swallow tube which transports food from the mouth to the stomach. A hole in the esophagus to the trachea (tracheo-esophageal fistula) would allow swallowed food/liquid to pass from the esophagus over to the trachea and into the lungs leading to pneumonia and bronchitis. This uncontrollable aspiration can potentially be life threatening as the hole could also allow food to pass BETWEEN the trachea and esophagus right down to the heart leading to possible mediastinitis (inflammation/infection of the heart lining).

Treatment initially would be placement of a feeding tube and a long course of IV antibiotics. If the hole does not spontaneously close, it would require surgical closure, typically with a flap of some kind.

The easiest test to perform to determine whether the hole has closed up or not is a swallow study using gastrografin or barium. Watch a video of how this test is performed.


As the news story mentioned, he was VERY lucky the nail went in where it did. If it went in a little further to the right or left, it could have punctured his carotid or jugular vein and he would have bled to death.

Reference:
Carpenter Shoots Himself In Neck With Nail Gun. WCVB Boston News
Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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