Introduction: Needlefish penetrating injuries have become a worldwide problem, inflicting critical morbidities and even mortalities. This is the first published case of needlefish injury in the Mediterranean basin.
Case report: A 29 year old man was admitted to Meir Medical Centre in Israel with a penetrating facial wound caused by elongated needlefish jaws. The severity of the wound contrasted greatly with the expected injury from collision with a fish inflicting a small penetration lesion. The rigid jaws penetrated the maxilla transversely and obliquely from the left canine-fossae, through the nasal cavity, and to the right maxillary sinus, with its tip reaching the right medial-inferior orbital wall. The needlefish jaws were completely removed using a combined endoscopic and external approach. The course of surgery and hospitalization was uneventful and the patient was discharged with no complications.
Conclusions: Fish inflicted critical facial injuries might be dangerously underestimated prima facie. The impact might be energetic enough to penetrate deep facial and vital cranial structures, hence thorough examination and imaging are recommended. Needlefish species are now common in the tropical and subtropical regions of all oceans and therefore this phenomenon is of interest to worldwide trauma medical providers, fishermen, divers, and also to marine-biologists.