Violence-related periorbital trauma with a retained foreign body: a case report

Abstract

BackgroundOrbital fracture usually occurs as a result of blunt orbital and facial trauma and may involve ocular injuries. International studies on orbital floor fracture show several differences in epidemiology, diagnostic criteria, surgical treatment modalities, and complication rates; therefore, any comparison should be made with caution. Here we describe an unusual case involving a 19-year-old man with violence-related periorbital trauma, wherein a foreign body (a plastic pen cap) traversed the median wall of the maxillary sinus and penetrated the lower turbinate.Case presentationA 19-year-old Caucasian man was referred to our department with localized pain and swelling in the left suborbital region following a physical fight in May 2014. A clinical examination revealed no abnormalities in his eyeballs or eye movement, palpation of the orbital contour revealed no fractures, and ophthalmological evaluation showed no evidence of diplopia. A computed tomography scan revealed fractures in the left orbital floor, periorbital tissue herniation without muscular entrapment and left maxillary hemosinus were observed. A hypodense soft tissue mass was lodged in the left orbital floor, which extended to the median wall of the maxillary sinus and penetrated the left lower turbinate. Surgical exploration of the foreign body was conducted, revealing the foreign body to be a pen cap.ConclusionsHistory or clinical examination alone may be inadequate to raise the suspicion of a retained periorbital foreign body in a situation of orbital region trauma. Computed tomography is important for the evaluation of periorbital injuries, especially because it could reveal the presence of a foreign body. Periorbital foreign bodies can be observed distinctly on computed tomography, which remains the most sensitive study and should be the first imaging modality in such cases.

Intraorbital penetrating and retained foreign bodies –a neurosurgical case series

“…Orbital infection of various severity grades was relatively frequent in our series, 15.38% of the cases. provide good access, good hemostasis, safety for the intraorbital structures (4), and the entry wound should be used when possible (5,12,22). Maxillofacial and plastic surgeons mostly use anterior approaches (29,35), and ophthalmologists use anterior and lateral approaches (14).…”

“…The particularities of the orbital region, being at the limit between the neurocranium and the viscerocranium and the context of orbital trauma raise the need for a complex multidisciplinary management including neurosurgery, ophthalmology, otolaryngology, maxillofacial surgery and plastic surgery (12,23,26,30).…”

“…Wooden foreign bodies are particularly difficult to remove due to their soft structure, making them prone to fracture during extraction with the risk of remnant fragments and consequent infection (4). Indications for surgical removal of foreign bodies include sharp foreign body, organic material, foreign body toxicity, mechanical restrictions of ocular motility, neurological deficits, compression of the intra-orbital structures, exophthalmia, development of infection, orbital fistula formation, and pain (1,10,12,24,27). In contrast, surgical removal is not required for blunt inorganic, asymptomatic, or deeply located foreign bodies (10).…”

Clinical diagnosis and treatment of intraorbital wooden foreign bodies

“…Wooden foreign bodies present low density or even are invisible on CT scan. The quantity and composition of foreign bodies are very difficult to identify, and the CT images of wooden foreign bodies will vary with time, which often leads to misdiagnosis or missed diagnosis 3, 4, 5. Wooden foreign bodies due to the pore on their surface and the characteristics of organic matter, are a great bacterial growth medium, and if not promptly removed, they may lead to infection 6, 7.…”

Penetrating cranial injury with giant intraorbital foreign body

“…Непосредственные результаты лечения: а -удалённое инородное тело; б -фрагмент тела основной кости, смещённый в полость черепа (стрелка); в -воздух в стекловидной камере глаза (стрелка); г -регресс пнев-моцефалии адекватное лечение которых чревато фатальными последствиями. Крайне важна насторожённость врача при из-учении обстоятельств подобной травмы, оценке внешнего вида поступившего в приёмное отделе-ние пациента [10,28,37]. В описываемом случае наличие гигантского инородного тела в ране по-зволило сразу заподозрить не только проникаю-щее ранение глазницы, но и весьма вероятную пенетрацию мозговых оболочек.…”