Safe Removal of a Tightly Impacted Metal Vessel from the Face and Head of a Toddler using a Handheld Metal Cutter in the Emergency Department – A Case Report

Abstract
Background: Facial entrapment in rigid metallic objects is rare in toddlers and may pose risks including airway compromise, soft‑tissue injury, and psychological distress. Removal becomes challenging when non‑invasive methods fail and specialized tools are unavailable.
Case Report: A 3‑year‑old boy presented with a tightly impacted aluminum alloy vessel over the perioral region. Manual traction and lubrication were unsuccessful. A controlled bedside procedure using a handheld 6‑inch mini‑bolt cutter, combined with soft‑tissue protection and light procedural analgesia, enabled safe removal without injury. Bilateral otoscopic examination showed no hemotympanum. Non‑accidental injury was considered and excluded based on consistent history, absence of suspicious injuries, and normal examination.
Conclusion: This case demonstrates a safe, reproducible, low‑resource technique for managing unusual pediatric facial entrapments when specialized equipment is unavailable. Continuous monitoring, airway vigilance, and soft‑tissue protection are essential for safe execution.