Imaging foreign bodies in head and neck trauma: a pictorial review

Abstract

Open injuries bear the risk of foreign body contamination. Commonly encountered materials include gravel debris, glass fragments, wooden splinters or metal particles. While foreign body incorporation is obvious in some injury patterns, other injuries may not display hints of being contaminated with foreign body materials. Foreign objects that have not been detected and removed bear the risk of leading to severe wound infections and chronic wound healing disorders. Besides these severe health issues, medicolegal consequences should be considered. While an accurate clinical examination is the first step for the detection of foreign body materials, choosing the appropriate radiological imaging is decisive for the detection or non-detection of the foreign material. Especially in cases of impaired wound healing over time, the existence of an undetected foreign object needs to be considered.Here, we would like to give a practical radiological guide for the assessment of foreign objects in head and neck injuries by a special selection of patients with different injury patterns and various foreign body materials with regard to the present literature.

A foreign body lodged in the sub-mental space through to the retro-pharyngeal area: a review of anatomical risks and surgical approaches

“…Traditional approach to penetrating injuries of the neck were based on the external wound's location since the work of Monson et al (1967), it describes three zones [1,[4][5][6]. Full medical history and clinical exam are very important factors whenever the patient is stable [1].…”

“…-The different radiological tools have each their own advantages and limitations [1]. Several radiological tools have been utilized to assess penetrating injuries to the neck, CT scan with or without enhancement, angio-MRI, Doppler sonography, and angiography [5].…”

“…Radiological assessment depends on the expected material of the foreign body (wood, glass, metal, tooth, debris), in order to have a minimal rate of negative findings [1,5,7,8].…”

“…Multi-dimension computed tomography is most successful for detecting foreign bodies; however, it struggles with wooden objects [1,5]. Moreover, it reveals the integrity of aero-digestive tract, neuro-vascular structures, vertebrae, and the trajectory and often times the nature of the foreign body [4].…”

“…It has been progressively replacing MRI and angiography in diagnosis of neck injuries. 8 According to Fergueson et al, in absence of hard signs of vascular injury, selective arterial angiography has sensibly the same false-positive cases rate as clinical evaluation [5]. Besides, MRI could cause re-location of metallic objects and is generally counter-indicated, as metallic foreign bodies are considered ferromagnetic until proven otherwise [5].…”