We describe the management of a patient impaled through the lower subm
andibular area by the top spike of some ir on railings which immobilis
ed his jaw and blocked access to the trachea. The Fire Brigade used sp
ecialised equipment to art out a section of the railings so that the p
atient could be transported to hospital. Awake fibreoptic intubation w
as used to gain access to the patient's airway before induction of ana
esthesia.