Background <p>Penetrating maxillofacial injuries in children from unusual objects are rare but can cause significant functional and aesthetic morbidity. Rapid assessment with appropriate imaging and multidisciplinary management are essential to minimize complications. We report a rare pediatric case of deep maxillofacial penetration by an elastic rope hook, its radiological findings, management, and outcome.</p> Case report <p>A 10-year-old boy reported a deep penetrating injury to the right maxillofacial region from an elastic rope hook during unsupervised play. Examination revealed a small entry wound with no globe injury or obvious neurovascular deficit. Computed tomography with 3D reconstruction showed the metal hook traversing the right orbital floor and nasal structures, with the tip reaching the contralateral nasal cavity while sparing the globe and major neurovascular bundles. A multidisciplinary team—oral and maxillofacial surgery, otorhinolaryngology, ophthalmology, and radiology—planned removal under general anesthesia. Guided by preoperative imaging, the hook was extracted intact via a controlled approach without intraoperative complications. Postoperative recovery was uneventful, and at 6 months the patient demonstrated complete functional recovery, normal ocular and nasal function, and satisfactory cosmesis. Literature review suggests this is the second reported pediatric case of penetrating maxillofacial trauma caused by an elastic rope hook.</p> Conclusion <p>Complex transfacial trajectories from uncommon penetrating objects require immediate imaging and coordinated multidisciplinary intervention. Accurate localization and team-based surgical planning enable safe foreign-body removal and excellent functional and aesthetic outcomes in pediatric patients.</p>