# Craniofacial speargun injuries: report of three cases, literature review and proposed management guidelines for maxillo-facial surgeons

## TL;DR

This paper presents three rare craniofacial speargun injury cases and proposes management guidelines for maxillo-facial surgeons.

## Contribution

The paper introduces new management guidelines for rare craniofacial speargun injuries based on three case reports and literature review.

## Key findings

- Three distinct craniofacial speargun injury scenarios were successfully managed in a maxillofacial surgery setting.
- Literature review reveals common patterns in injury entry sites, trajectories, and complications.
- Key principles include early airway control, imaging, and anatomically driven extraction techniques.

## Abstract

Speargun injuries of the head and neck are extremely rare but potentially devastating because of the high density of vital structures in this region. Most available data derive from isolated case reports, and guidance specific to oral and maxillofacial surgeons remains limited. We report three patients with craniofacial speargun injuries managed in a maxillofacial surgery setting, illustrating three distinct scenarios with increasing complexity: an isolated sinonasal trajectory confined to the midface, an anterior cranial fossa trajectory following a submental/oral entry, and a transoral posterior fossa trajectory associated with diffuse haemorrhage and delayed neurological deterioration. Review of the literature confirms recurrent patterns in entry sites, trajectories, complications and outcomes, and supports several key principles: early airway control, systematic cross-sectional and vascular imaging, multidisciplinary planning, and anatomically driven choice between retrograde and anterograde extraction with watertight skull-base reconstruction. These concepts are crucial for maxillofacial surgeons facing these rare but high-risk injuries.

The online version contains supplementary material available at 10.1007/s10006-026-01534-8.