A retained wood penetrating the superior orbital fissure in a neurologically intact child

Abstract

Transorbital intracranial injuries due to a wooden foreign body traversing superior orbital fissure is an extremely rare condition. A 9-year-old boy was struck by a tree branch in the left eye while playing in the garden two months ago. On physical examination, the patient had only a hypertrophic scar on his medial side of left upper eyelid at the admission. A history of recurrent cutaneous fistula from the puncture site due to a retained foreign body was suspected, and the patient was hospitalized to evaluate and remove the object to prevent severe infection. Afterwards, the child was operated successfully via the left transcranial route to detect and remove the foreign body. The authors described an unusual case of wooden foreign body that traversed the superior orbital fissure yet caused no deficit and was associated with no fracture. Even if symptoms are absent, removal of a wooden foreign body should be immediately performed to prevent sight-threatening and lifethreatening complications. KeywoRds: Orbitocranial, Superior orbital fissure, Wooden, Foreign body ÖZSuperior orbital fissürü kateden ağaç yabancı cismin neden olduğu transorbitokranial yaralanmalar oldukça nadirdir. Dokuz yaşında erkek çocuk bahçede oynarken, ağaç parçası sol gözüne batmıştır. Başvuru sırasında fizik muayenede yalnızca sol üst göz kapağı medial kısmında hipertrofik skar bulunmuştur. Yaralanma noktasından tekrarlayan fistülün bir yabancı cisim şüphesine neden olmasıyla, incelemek ve şiddetli bir enfeksiyonu önlemek amacıyla çıkartmak üzere hastaneye yatırılmıştır. Ardından, saptanan yabancı cismi çıkartmak için transkranial yol kullanılarak başarı ile opere edilmiştir. Yazarlar, superior orbital fissürü katederek defisite ve kırığa neden olmayan nadir bir tahta yabancı cisim olgusu tanımlamıştır. Semptom olmasa bile tahta yabacı cismin çıkarılması, görmeyi ve hayatı tehdit eden komplikasyonları önlemek için hemen gerçekleştirilmelidir.

Clinical diagnosis and treatment of intraorbital wooden foreign bodies

“…A CT scan is usually performed in cases where foreign bodies are suspected. But it is well known that a wooden foreign body initially appears with low-density signal on CT scan, which mimics air bubbles 9, 10, 11. However the application of MRI in open injury is controversial, and we cannot completely exclude the possibility of metal foreign bodies.…”

Trauma intracraneal penetrante trans-orbitario: Anatomía relevante, las dinámicas del trauma y los puntos clave para el tratamiento

“…La segunda vía mas frecuente es a través de la fisura orbitaria superior (FOS), por la cual los cuerpos extraños ocasionalmente alcanzan el tallo cerebral a través del seno cavernoso y causan lesiones graves. Cuando los cuerpos extraños entran a través de la FOS, pueden causar trauma al tercer, al cuarto, al quinto y al sexto nervio craneal o pueden producir fístulas arteriales involucrando la arteria carótida interna (ACI) y el seno cavernoso [4][5][6][7][8][9][10] . En estos casos se pueden encontrar fístulas de líquido cefalorraquídeo, neumoencéfalo, celulitis orbitales, fístula carótido-cavernosa, infecciones del sistema nervioso central (SNC) y hemorragias intracraneales (HIC) 11,12 .…”

Penetrating head and brain injuries with nonmetal foreign bodies

“…Из-за низкой кинетической энергии ранящего предмета (в отличие от пулевых и осколочных ранений) и относительной прочности костей черепа основным путем проникновения инородного тела в полость черепа являются его «слабые места» в области естественных отверстий: верхняя глазничная щель [15][16][17][18], канал зрительного нерва [19], тонкие костные стенки орбиты [14,[19][20][21][22][23][24][25][26][27][28], решетчатая пластинка [10,30]. Вследствие такой локализации входного отверстия эта патология входит в сферу профессиональной деятельности как нейрохирургов, так и офтальмологов, краниофациальных хирургов, оториноларингологов и др.…”

“…С учетом возрастных особенностей (толщина костей, плотность швов) дети чаще взрослых страдают от проникающих ранений неметаллическими предметами [16,17,20,[30][31][32].…”

“…Сроки их развития, по данным разных авторов [8,14,28,29,35,40,48], варьируют от 2 дней до 7 лет. Микробный пейзаж гнойных осложнений представлен следующей флорой: Staphylococcus aureus, Streptococcus mitis, Bacteroides spp., Enterobacteriaceae [6,11,17,23,36,49].…”