Clinical diagnosis and treatment of intraorbital wooden foreign bodies

Abstract

PurposeThe intraorbital wooden foreign body is often misdiagnosed or missed on computed tomography (CT) scan, due to the invisible or unclear images. The residual foreign bodies often occur during surgical removal. The clinical manifestations, imaging features and treatment of intraorbital wooden foreign bodies were discussed in this study.MethodWe retrospectively analyzed 14 cases of intraorbital wooden foreign bodies managed at our hospital between January 2007 and May 2015. All patients underwent orbital CT examination before surgery, and surgery was performed under general anesthesia with orbital wound debridement and suture, as well as exploration and removal of wooden foreign bodies.ResultsAt first, 11 cases underwent removal of foreign bodies, including 1 case with incomplete removal and then receiving a secondary surgery. Foreign bodies were not found in three cases with preoperative misdiagnosis and orbital MRI found residual foreign bodies in the orbit. Operations were performed via primary wound approach in eight cases, conjunctival approach in two cases, and anterior orbitotomy in four cases. Postoperatively, one case was complicated with eye injuries, three cases with ocular muscle injuries, eight cases with visual loss, and eight cases with orbital abscess. The length of foreign bodies ranged from 1.8 cm to 11.0 cm. The maximum of four foreign bodies were removed at the same time.ConclusionBecause the imaging of orbital wooden foreign bodies is complex and varied, MRI should be combined when they are invisible on CT scan. At the same time injuries trajectory and clinical manifestations of patients should be taken into account. Surgical exploration should be extensive and thorough, and foreign bodies and orbital abscess must be cleared.

Intraorbital penetrating and retained foreign bodies –a neurosurgical case series

“…Its position can be extraconal or intraconal (37), and it can be classified as metallic or nonmetallic; in turn, nonmetallic IOFBs can be organic or inorganic (38). IOFBs typically occur in males, children, and young adults with a history of work accidents or gunshot injuries involving high-velocity projection (2,10,22,29).…”

Clinical Inspection and Image Exams Evaluation of Traumatic Wounds: A Case Report

“…Young adults, as reported in the present manuscript, represent the most affected age group [4,5]. With regard to the face, the anatomy is emphasized as differentiated due to the underlying bone tissues that favor soft tissue rupture, especially the orbit that represents a critical and vulnerable region since the fragile and friable tissue, together with the conformation of the eyelids, favor the retention and penetration of foreign bodies [6].…”

“…The sutures previously made in the face were removed, the visualization and access of the fractures/foreign bodies performed. In situations where there are punctiform injuries, blind inspection and clamping of foreign bodies must not be performed since damage to important structures may occur [5,6].…”

“…In the suspicion of any foreign body inside the wound, additional examinations must be performed in order to identify, locate and quantify the fragments. Several modalities of imaging have already been used and studied in the identification of foreign bodies, among them the use of radiographs, computed tomography, ultrasound and even magnetic resonance, although there is no consensus on the best method to be used in the identification of foreign bodies [5,6,9]. mass suture was carried out by another team which we believe had the primary purpose of providing hemostasis ( Figures 1A and Figure 1B).…”

“…It is considered a method of low precision and accuracy of foreign body position. Magnetic resonance imaging is the most costly and most inaccessible method and from a diagnostic point of view, may present faults in identifying certain objects such as wood and should not be used when metallic and ferromagnetic foreign bodies are suspected [6,9].…”