A 30-year-old male suffered an accident while loading a speargun at home. The emergency services were notified. After protocol "A, B, C" the clinical examination of the patient showed only a penetrating wound at the level of the submandibular region.
The approximate size of the spear was 80 cm long and 1 cm in diameter with an intracranial trajectory of about 15 cm. The firefighters carefully cut the harpoon to facilitate the transfer of the patient to hospital.
The patient was haemodynamically stable, alert and oriented (Glasgow 15), with no neurological deficit and no active bleeding. There were blood clots in the left ear canal.
There was no cerebrospinal fluid leaking from the entry wound or the external auditory canal. The lateral skull X-ray showed the trajectory, direction and the existence of a beard mechanism in the harpoon. An emergency CT scan was performed which showed the direction of the arrow. The entry orifice was in the left submaxillary region and penetrated to the carotid siphon of the left temporal bone crest, passing very close to the petrosal sinus. The flap of the harpoon was located at the level of the left mandibular condyle on its inner side. Under general anaesthesia and nasotracheal intubation, the patient was placed in a supine and neutral head position. The position of the harpoon, adjacent to the left mandibular condyle, made oral opening difficult. Despite this, access was made intraorally at the level of the left tonsillar pillar. A 4 cm incision was made. Through this approach, the harpoon was exposed at the level of the flipper mechanism. Subsequently, the barba mechanism of the harpoon was inactivated by means of a steel wire ligature.

Finally, under intraoral control, the harpoon was extracted in the opposite direction to its entry.

No cerebrospinal fluid was observed to leak from the entry wound or from the intraoral access. The intraoral wound was sutured with 3/0 vicryl, the subcutaneous with 4/0 vicryl and the submandibular wound with 4/0 prolene.
Immediately after the operation, a follow-up CT scan was performed, showing only a small pneumocephalus.

The patient was kept under observation for 24 hours without showing neurological focality. Subsequently, he went to the ward and was discharged on postoperative day 3 without any neurological disorder. No complications were reported.
One month later, an audiometry was performed which revealed a conductive hearing loss of 60% in the left ear.
The patient is now living a normal life and is only waiting for a hearing aid.