We describe the management of a patient impaled through the medial aspect of the left orbit by the brake lever of a mountain bike which immobilized her jaw by obstructing the right coronoid process of the mandible and blocked access to the mouth and trachea. The fire service used special equipment to cut out the rest of the bike from the handle bar. The patient with the penetrating brake lever attached to the handlebar in situ was transported to the hospital by rescue helicopter. The assessment and safe airway management and potential difficulties are discussed.
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