CT Angiography Evaluation of Unusual Transorbital Penetrating Injury: A Toothbrush

Atay, Musa; Alkan, Alpay; Hanımoğlu, Hakan; Sharifov, Rasul; Kılıçarslan, Rukiye; Aralaşmak, Ayşe

doi:10.1111/jon.12003

Cited by 11 publications

(8 citation statements)

References 8 publications

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Clinical diagnosis and treatment of intraorbital wooden foreign bodies

Zhou

Jin

et al. 2016

Chinese Journal of Traumatology

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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.

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Section: Discussionmentioning

confidence: 99%

Clinical diagnosis and treatment of intraorbital wooden foreign bodies

Zhou

Jin

et al. 2016

Chinese Journal of Traumatology

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“…Penetrating injuries in civilian setup are uncommon. The various objects reported include pencil, 6 metal, 7 bicycle handle, 8 knife, 9 penetrating gunshot, 10 toothbrush, 11 and arrow. 12 Transorbital penetrating craniocerebral injuries are more common in the pediatric population as compared with adults and are very rare in the geriatric age group.…”

Section: Discussionmentioning

confidence: 99%

Civilian Occult Orbitocranial Penetrating Injury Presenting with Cerebral Abscess in Elderly Patient

Mulla

Bhende

Patil

et al. 2017

IJNT

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Orbital penetrating injuries are uncommon and occur following accidental entry of objects through orbit. The authors report an interesting case of right frontal abscess resulting from orbitocranial penetrating injury due to accidental penetration of wooden stick into the right eye, which remained undiagnosed. A 70-year-man presented with complaints of headache and vomiting for few days. His computed tomographic (CT) scan of the brain revealed peripheral rim-enhancing cystic lesion in the right frontal lobe with perilesional edema, mass effect, and midline shift. Orbital CT scan revealed hyperdense lesion just lateral to medial orbital wall. Magnetic resonance imaging of the brain showed cystic peripheral rim-enhancing lesion that was homogenous hypointense on T1-weighted images and homogenous hyperintense on T2-weighted images. The patient underwent right frontal craniotomy. Pus was drained out, and abscess wall was excised. Foreign bodies protruding through fractured orbital roof were found and removed. He made good clinical recovery. He has received intravenous antibiotics for 2 weeks followed by 4 weeks of oral antibiotics. He had no visual symptoms. The authors report the case, review the literature, and highlight need for imaging in every case of orbital penetrating injury to prevent the life-threatening cerebral parenchymal complications.

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“…The procedure may take up to an hour, which is questionable for unstable trauma patients and has therefore been recently superseded by CT angiography (CTA) 4,18,55. CTA demonstrates the course of the foreign object in relationship to the cerebral structures of the brain and any possible vascular injury 5. Added benefits to CTA involve the wide availability of CT scanners, it is minimally invasive and has a short acquisition time (<1 min).…”

Section: Role Of Angiographymentioning

confidence: 99%

“…4,18,55 CTA demonstrates the course of the foreign object in relationship to the cerebral structures of the brain and any possible vascular injury. 5 Added benefits to CTA involve the wide availability of CT scanners, it is minimally invasive and has a short acquisition time (<1 min). Disadvantages compared to conventional angiography include potential degradation of image quality from artefacts, and no possibility of therapeutic intervention directly after diagnosis (Fig.…”

Section: Role Of Angiographymentioning

confidence: 99%

“…PBIs are less prevalent than blunt head injuries, representing ∼0.4% of injuries, however, they often have more complex damage, worse prognosis and higher rates of morbidity and mortality 1,2. Bullets are the most common foreign bodies in PBI,3 however, chopsticks,4 toothbrushes,5 nails6 and knives7 have also been reported. Foreign bodies into the cranium pose immediate complications, such as pneumocephalus, intracerebral haemorrhage, contusions and brain stem injury, which, in the short to medium term sequelae, can lead to abscesses, meningitis and encephalitis 4.…”

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confidence: 99%

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Neuroimaging in adult penetrating brain injury: a guide for radiographers

Temple

Donald

Skora

et al. 2015

J of Medical Radiation Sci

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Penetrating brain injuries (PBI) are a medical emergency, often resulting in complex damage and high mortality rates. Neuroimaging is essential to evaluate the location and extent of injuries, and to manage them accordingly. Currently, a myriad of imaging modalities are included in the diagnostic workup for adult PBI, including skull radiography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography, with each modality providing their own particular benefits. This literature review explores the current modalities available for investigating PBI and aims to assist in decision making for the appropriate use of diagnostic imaging when presented with an adult PBI. Based on the current literature, the authors have developed an imaging pathway for adult penetrating brain injury that functions as both a learning tool and reference guide for radiographers and other health professionals. Currently, CT is recommended as the imaging modality of choice for the initial assessment of PBI patients, while MRI is important in the sub-acute setting where it aids prognosis prediction and rehabilitation planning, Additional follow-up imaging, such as angiography, should be dependent upon clinical findings.

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CT Angiography Evaluation of Unusual Transorbital Penetrating Injury: A Toothbrush

Cited by 11 publications

References 8 publications

Clinical diagnosis and treatment of intraorbital wooden foreign bodies

Clinical diagnosis and treatment of intraorbital wooden foreign bodies

Civilian Occult Orbitocranial Penetrating Injury Presenting with Cerebral Abscess in Elderly Patient

Neuroimaging in adult penetrating brain injury: a guide for radiographers

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