DISCUSSION
Injuries to the oral cavity by toothbrushes are common in children, but impalement by a toothbrush is rare. Few cases have been reported, even in children.1,2 The injury in this case was particularly life-threatening because of the mediastinal emphysema around the left carotid arteries. Had the toothbrush penetrated either artery, the child could have died from blood loss. If the emphysema had worsened, he might have died from airway obstruction or functional loss of blood circulation. Supervised or not, children typically use a toothbrush every day. Parents, dentists, and physicians should all be aware of the potential dangers.