Crochet Hook to…the Mouth…..?

    Gynecological problems are not the only injuries to appear in the annals of the medicals books as having been caused by a crochet needle. They really only get worse from there. Surprised? You shouldn’t be. There’s also a lesson here about carelessness and clumsy children (don’t worry this one is just fine).

    A 4-year-old boy was admitted to the hospital in 2007 after falling down on a crochet needle, which was in his hand. The needle had gone through his mouth and got stuck. Attempts to remove it at home proved futile. This was a double sided crochet needle with one side lodged and the other sticking out of his mouth. 

    His symptoms included; bleeding from his mouth, there was no loss of consciousness, pain or giddiness. The crochet needle, protruding out from his mouth, had penetrated the soft palate. For those of you who don’t know the soft palate, also called palatal velum or muscular palate in mammals is a structure consisting of muscle and connective tissue that forms the roof or the rear portion of your mouth, or oral cavity. Go ahead I’ll pause while you look in the mirror to imagine a crochet needle getting stuck in the back of your throat…..3..2…1 

    Okay as we were saying…..

    He was afebrile and had no neurological deficits. X-ray of the head showed that one tip of the crochet needle had penetrated into the skull. CT scan with 3-dimensional reconstruction showed that the crochet needle had passed through the jugular foramen into the posterior fossa and the tip was embedded in the cerebellar parenchyma. Refer to the picture if you want a general idea about where any of those things are.

    The patient was taken up for an emergency right suboccipital craniectomy. A suboccipital craniectomy refers to a surgical procedure that is performed at the base of the brain in which a portion of the skull is removed to access the surgical objective. The portion of the skull is not replaced, instead, the area is covered with a synthetic substance. He was intubated in the supine position and operated on in the left lateral position. The cerebellum was removed and the tip of the crochet needle reached. The tip was cut with a small bone cutter and both fragments were removed.     Initially there was profuse bleeding from the entry wound in his mouth, which was controlled by pressure. There was no bleeding into the posterior fossa. Once the bleeding had stopped, he underwent usual closure. 

    Postoperatively, recovery from anesthesia was uneventful and there was no neurological deficit. He was started on broad-spectrum IV antibiotics and was closely monitored for 72 h for development of hematoma or infection. As he continued to remain asymptomatic, he was discharged from hospital. At 6 months of follow-up, the child was doing well and had no complaints related to his injury.