Review of Phineas Gage’s Oral and Maxillofacial Injuries

A large iron rod weighing 13.25 pounds passed through Gage's head and surprisingly he lived 12 years with this injury. Though Gage survived this injury, his personality changed drastically. “Gage was no longer Gage”, he changed from an even tempered man to being “fitful, irreverent, indulging at times in the grossest profanity”. These events helped establish the relationship between personality and the frontal region of the brain. However, his maxillofacial injuries are seldom noted. In this study, we reviewed previous texts and journal articles to enable a mapping of the trajectory of the iron rod through his maxillofacial region. The iron rod first pierced through his left cheek, lateral to the mandible, anterior to the masseter muscle, and anterior to the parotid gland, therefore not penetrating the oral cavity. The zygomatic bone was then fractured and laterally displaced. The rod continued into the infratemporal fossa, apparently anterior to the pterygoid plexus and then entered the posterior orbit. It penetrated the cranial fossa through the frontal bone: Its trajectory was anterior to the cavernous sinus. It then penetrated the orbital portion of the frontal lobe before exiting the skull. Although Phineas Gage's brain injuries are important, it is equally important to look at his maxillofacial injuries. The iron rod missed some major venous plexuses that could have possibly caused fatal bleeding.