Sir, a 30-year-old carpenter attended the A&E department complaining of a laceration to his cheek and an altered bite following a nail gun misfiring at work. On clinical examination, he had a 1 cm linear laceration to his right cheek and was unable to occlude his teeth. Radiographs (Fig. 1) revealed an 8 cm nail traversing the maxilla.
Occipitomental 0 and 30 degree radiographs showing 8 cm nail across maxilla
It is estimated that nail gun injuries are responsible for 37,000 A&E attendances each year and reports state that the number of injuries are increasing.1 A number of these cases resulted in significant morbidities and could have been prevented by improved personal protective equipment. Current guidelines recommend wearing hard hats and eye protection only, when operating a nail gun.2 We would suggest that these guidelines could be revised to include full-face protection due to the severity of related injuries.
The nail was removed under general anaesthetic via a second incision in the right cheek. The patient was reviewed two weeks post operatively and had no long term complications from his injury.
References
Lipscomb H, Jackson L. Nail-gun injuries treated in emergency departments - United States, 2001-2005. MMWR Morb Mortal Wkly Rep 2007; 56: 329-332.
Department of Health and Human Services; Centers for Disease Control and Prevention; National Institute for Occupational Safety and Health; Department of Labor; Occupational Safety and Health Administration. Nail gun safety: a guide for construction contractors. 2011. Available at: https://www.osha.gov/Publications/NailgunFinal_508_02_optimized.pdf (accessed July 2019).
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Brown, D., Collard, B. & McLennan, A. Nail gun injury. Br Dent J 227, 177 (2019). https://doi.org/10.1038/s41415-019-0626-7
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DOI: https://doi.org/10.1038/s41415-019-0626-7
