To judge by the Google images for Khazouk, impalement from the mouth downwards must be a minority sport. Most guys take the stake up the arse, though it is rarely shown coming out of the mouth - rather the exit point is around the shoulder somewhere. There are suggestions that victims could last for hours, up to a day or two. Whether that's a horrible way to go depends a bit on how much you want to be raised up on a giant, piercing, dildo for your last hours.
Great picture, Desouza, as always.