RESUMO
Penetrating transorbital injury with skull base involvement is a rare occurrence from a crayon. We report a case of a 2-year-old male who sustained a penetrating crayon injury through the right orbit and lamina papyracea into the posterior ethmoid sinus complicated by cerebrospinal fluid leak. There have been no other reported cases of this type of injury by a crayon.
Assuntos
Vazamento de Líquido Cefalorraquidiano/etiologia , Seio Etmoidal/lesões , Órbita/lesões , Jogos e Brinquedos , Ferimentos Penetrantes/complicações , Acidentes por Quedas , Pré-Escolar , Seio Etmoidal/diagnóstico por imagem , Humanos , Masculino , Órbita/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ferimentos Penetrantes/diagnóstico por imagemRESUMO
Orbital trauma is often associated with foreign bodies. Wooden foreign bodies pose an urgent need for removal owing to their reactive nature and the high risk for infection. Though visual prognosis depends on associated ocular trauma, in selected cases, excellent visual and cosmetic outcomes are possible. An 18-year-old woman presented to our trauma facility with a history of fall directly onto a wooden stick from a height. On examination, there was a large wooden foreign body in the left medial orbit, extending into the ethmoidal sinus as visualised on imaging. After administration of perioperative antibiotics, the foreign body was removed in toto using careful tissue dissection and the soft tissue was closed in layers. Postoperatively at six months, the vision in the left eye was 20/20 with mild ptosis. Early surgery, careful dissection of soft tissues and adequate infection prophylaxis can lead to good outcomes in such cases.
Assuntos
Corpos Estranhos no Olho/etiologia , Órbita/lesões , Madeira/efeitos adversos , Adolescente , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/lesões , Seio Etmoidal/cirurgia , Corpos Estranhos no Olho/diagnóstico , Corpos Estranhos no Olho/cirurgia , Feminino , Humanos , Órbita/diagnóstico por imagem , Órbita/cirurgia , Resultado do TratamentoRESUMO
INTRODUCTION: Penetrating craniofacial injuries caused by stick-like foreign bodies occur as a result of accidents particularly in children, and often lead to significant morbidity. CASE SUMMARY: We describe a 5-year-old boy who sustained facial trauma after falling on a wooden stick which penetrated his left cheek. At the initial visit, his vital and neurological signs were normal. However, the stick had penetrated the frontal lobe to a depth of 3cm via the orbital cavity and the anterior skull base. The stick was successfully removed while visualizing the anterior skull base in an endoscopic transethmoidal approach. A follow-up examination one year after the accident demonstrated normal visual acuity and ocular motility, with no diplopia, tearing or pain. DISCUSSION: Penetrating facial injuries caused by stick-like objects carry a significantly higher risk of serious neurological involvement. Even if penetrating facial injuries sometimes appear trivial, the external injury site is often insufficient to determine the position of the object within the head. Although the cheek is a rare entry site for intracranial injuries, the extent of damage should be assessed fully before attempting removal.
Assuntos
Bochecha/lesões , Corpos Estranhos/complicações , Lobo Frontal/lesões , Ferimentos Penetrantes/complicações , Bochecha/cirurgia , Pré-Escolar , Endoscopia , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/lesões , Seio Etmoidal/cirurgia , Corpos Estranhos/cirurgia , Lobo Frontal/diagnóstico por imagem , Lobo Frontal/cirurgia , Humanos , Imageamento Tridimensional , Masculino , Órbita/diagnóstico por imagem , Órbita/lesões , Órbita/cirurgia , Tomografia Computadorizada por Raios X , Ferimentos Penetrantes/etiologia , Ferimentos Penetrantes/cirurgiaRESUMO
From time to time, severe or fatal injuries caused by small caliber air rifle projectiles are seen. In forensic sciences, the theoretical wounding potential of these weapons and projectiles is widely known. Usually, shots against the skull were reported and, in these cases, penetrating the eyes or thin bone layers of the temporal region. Amongst a huge number of different projectiles available for air guns, sub-caliber 4.4-mm (.173) caliber steel ball projectiles were used in an unusual suicide case. This case led to fundamental questions concerning wound ballistics. An 82-year-old man shot once against his right temporal region and twice into his mouth with a 4.5-mm (.177) caliber air rifle. Because of the exceptionally deep penetration of the base of the skull and the use of spherical-shaped sub-caliber air rifle projectiles, terminal ballistic features were analyzed and compared to results published in forensic literature. Test shots using the same weapon and similar projectiles were fired into ballistic gelatin to measure and calculate basic wound ballistic variables of cal. 4.4-mm (.173) steel balls. In comparison, further test shots with cal. 4.5-mm (.177) steel balls BB (ball bearing), flat-headed and pointed air rifle pellets ("diabolos") were carried out. The theoretical penetration depth in solid bone was calculated with 36.4 mm, and test shots in gelatin from hard contact produced an on-average wound track of 120 mm underlining the potential wounding effect. Furthermore, spherical projectiles could roll back and forth within the barrel, and an air cushion between projectile and breechblock can reduce muzzle velocity by more than half, explaining the retained missile in the temporal region.
Assuntos
Armas de Fogo , Balística Forense , Traumatismos Cranianos Penetrantes/patologia , Ferimentos por Arma de Fogo/patologia , Idoso de 80 Anos ou mais , Seio Etmoidal/lesões , Seio Etmoidal/patologia , Gelatina , Humanos , Cinética , Masculino , Modelos Biológicos , Palato/lesões , Palato/patologia , Crânio/lesões , Crânio/patologia , AçoAssuntos
Seio Etmoidal/lesões , Corpos Estranhos no Olho/diagnóstico , Ferimentos Oculares Penetrantes/diagnóstico , Órbita/lesões , Adulto , Seio Etmoidal/diagnóstico por imagem , Corpos Estranhos no Olho/etiologia , Ferimentos Oculares Penetrantes/complicações , Humanos , Masculino , Órbita/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaAssuntos
Artérias/cirurgia , Epistaxe/cirurgia , Seio Etmoidal/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Artérias/diagnóstico por imagem , Epistaxe/diagnóstico por imagem , Epistaxe/etiologia , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/lesões , Humanos , Ligadura , Procedimentos Cirúrgicos Otorrinolaringológicos/instrumentação , Instrumentos Cirúrgicos , Tomografia Computadorizada por Raios XRESUMO
Penetrating cervical lesions caused by a foreign body are rare events. The neck is a complex and delicate body region, given the important vascular structures it holds. The most frequent fatal complications often involve vascular injuries, and as a consequence, the mortality rate increases by approximately 50%. Civilian patients are mainly victims of violence or motor vehicle accidents and rural accidents involving neck are not very common. When a cervical lesion is because of a wooden foreign body, infectious risk increases for its organic peculiarity. The authors report a rural nonfatal cervical lesion in a civilian, and its management.
Assuntos
Corpos Estranhos/complicações , Lesões do Pescoço/etiologia , Ferimentos Penetrantes/etiologia , Endoscopia/métodos , Seio Etmoidal/lesões , Seguimentos , Corpos Estranhos/cirurgia , Hemostasia Cirúrgica/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/lesões , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/cirurgia , Fraturas Orbitárias/diagnóstico , Fraturas Orbitárias/etiologia , Fraturas Orbitárias/cirurgia , Madeira , Ferimentos Penetrantes/diagnóstico , Ferimentos Penetrantes/cirurgiaRESUMO
Weapon injuries with spear gun are rare. The aim of this case report is to report the emergency and surgical management when this event occurs. A 35-year-old man attempted suicide with a spear gun. The entry of the shaft was localized through the submental area without an obvious exit point. The projectile passed through the tongue and palatal bone. A tracheotomy was performed. Preoperative cranial computed tomography (CT) showed the harpoon was gone upward through the submental area, the oral cavity, the ethmoid paranasal sinus, the cribriform plate, and the frontal region without vessel damages. Under general anesthesia, the harpoon was pulled out in order to extract the shaft tip and the articulated wishbone. Osteo-meningeal defect of the ethmoid roof was closed using a middle turbinate flap. There were no neurologic deficit and no cerebro-spinal rhinorrhea at his 3-year follow-up visit. The trajectory of the shaft is different between attempted suicide and accident. Cranial CT scan is helpful to show the trajectory of the shaft. Angiogram can be helpful to see the relations between the tip shaft and the vessels. The knowledge of the shaft tip and the imagery findings are important to decide the best surgical approach.
Assuntos
Traumatismos Maxilofaciais/etiologia , Tentativa de Suicídio , Ferimentos Penetrantes/etiologia , Adulto , Angiografia/métodos , Osso Etmoide/diagnóstico por imagem , Osso Etmoide/lesões , Seio Etmoidal/lesões , Lobo Frontal/lesões , Humanos , Masculino , Traumatismos Maxilofaciais/diagnóstico por imagem , Boca/lesões , Cirurgia Endoscópica por Orifício Natural/métodos , Palato Duro/lesões , Retalhos Cirúrgicos/cirurgia , Tomografia Computadorizada por Raios X , Língua/lesões , Resultado do Tratamento , Ferimentos Penetrantes/diagnóstico por imagemRESUMO
OBJECTIVE: The description of a new approach for the management of patients with frontal sinus fractures and associated obstruction of the frontal outflow tract to, restore sinus function and avoiding sinus obliteration. SUBJECTS AND METHODS: In a prospective study, 21 patients with anterior wall frontal sinus fractures associated with potential obstruction of the frontal outflow tract, underwent rigid internal fixation and intraoperative guarded nasal endoscopic debridement of any bony spicules and lacerated mucosa to clear the frontal recess. Patients were followed up clinically and radiologically by CT to assess the status of the frontal sinus and to detect any manifestations of frontal sinusitis or any other complications. RESULTS: Seventeen patients completed the postoperative follow-up while four patients were excluded from the study. Postoperative follow-up ranged from 6 to 34 months with a mean of 20 months. All patients had associated craniofacial fractures. Follow-up CT scans showed complete restoration of frontal sinus ventilation and mucociliary clearance for 13 patients. Four patients showed frontal sinus mild mucosal thickening without signs of chronic sinusitis. CONCLUSION: Patients with anterior wall frontal sinus fractures associated with frontal sinus outflow tract obstruction could be successfully managed with rigid internal fixation and intraoperative guarded endoscopic debridement of any bony spicules and lacerated mucosa to clear the frontal recess. This type of management could increase the chance of frontal sinus preservation and decrease the need for frontal sinus obliteration for similar patients.
Assuntos
Seio Frontal/lesões , Sinusite Frontal/prevenção & controle , Fraturas Cranianas/cirurgia , Adolescente , Adulto , Desbridamento/métodos , Endoscopia/métodos , Seio Etmoidal/lesões , Seio Etmoidal/cirurgia , Seguimentos , Fixação Interna de Fraturas/métodos , Seio Frontal/cirurgia , Sinusite Frontal/etiologia , Humanos , Processamento de Imagem Assistida por Computador/métodos , Cuidados Intraoperatórios , Masculino , Depuração Mucociliar/fisiologia , Osso Nasal/lesões , Osso Nasal/cirurgia , Mucosa Nasal/cirurgia , Fraturas Orbitárias/cirurgia , Estudos Prospectivos , Fraturas Cranianas/complicações , Tomografia Computadorizada por Raios X/métodos , Adulto JovemRESUMO
BACKGROUND: Migration of a dental implant into the paranasal sinuses may be the result of sinus membrane perforation, loss of osseointegration, and lack of initial stability. The majority of displaced implants migrate into the maxillary sinus, which may cause sinusitis. PURPOSE: The purpose of this study is to report an extremely rare ethmoid sinus migration of a dental implant after crestal approach in a resorbed posterior maxilla. MATERIALS AND METHODS: A 60-year old Korean male with a noncontributory medical history was referred from a local clinic to remove the migrated dental implant in the right ethmoid sinus. The patient had symptoms of mild sinusitis. The implant had been placed 6 months earlier through the bone-added transalveolar approach in a severely resorbed maxilla. RESULTS: The displaced implant was removed through the intraoral approach. A lateral window was made and an endoscopic surgery was performed to remove the implant. Healing was uneventful, and sinusitis symptom had ceased. CONCLUSION: The crestal approach for severely resorbed posterior maxillae should be performed when there is a potential for primary stability. If bone quality is poor and initial stability cannot be achieved, lateral window sinus elevation procedure is a better option for successful implant placement. Migrated implant may be removed with antrostomy and endoscopic surgery.
Assuntos
Implantes Dentários/efeitos adversos , Seio Etmoidal/lesões , Migração de Corpo Estranho/cirurgia , Seio Etmoidal/diagnóstico por imagem , Migração de Corpo Estranho/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia PanorâmicaRESUMO
Naso-orbitoethmoid fractures account for 5% of all facial fractures. We used data derived from a white 34-year-old man to make a transient dynamic finite element model, which consisted of about 740 000 elements, to simulate fist-like impacts to this anatomically complex area. Finite element analysis showed a pattern of von Mises stresses beyond the yield criterion of bone that corresponded with fractures commonly seen clinically. Finite element models can be used to simulate injuries to the human skull, and provide information about the pathogenesis of different types of fracture.
Assuntos
Seio Etmoidal/lesões , Análise de Elementos Finitos , Osso Nasal/lesões , Fraturas Orbitárias/fisiopatologia , Fraturas Cranianas/fisiopatologia , Adulto , Fenômenos Biomecânicos , Densidade Óssea/fisiologia , Simulação por Computador , Módulo de Elasticidade , Humanos , Masculino , Modelos Biológicos , Estresse Mecânico , Tomografia Computadorizada por Raios X/métodos , Interface Usuário-Computador , ViolênciaRESUMO
OBJECTIVE: The aim of this study was to develop and test the utility of a novel systematic protocol to analyze CT images of patients with trauma in the anterior cranial base and upper midface. MATERIAL AND METHODS: The radiological data and primary reports of 27 consecutive patients with a frontal skull base fracture treated in two tertiary care hospitals from 2007 to 2011 were scrutinized. A novel algorithm for systematic image reviewing was used to assess the CT images and the findings were compared with the primary radiological reports. RESULTS: The systematic review detected a substantial number of fractures and defects in anatomical structures that had not been systematically reported in the primary, on-call reports. Anterior skull base fracture was not initially reported in 32% of the patients; however, the algorithm detected this in 93% of them. The corresponding rates for fracture through cribriform plate were 28% and 72% and for fracture through the sella or hypophyseal area 22% and 78%. There were two fractures of the clivus and these were initially missed. CONCLUSIONS: Despite the failure to identify these fractures radiologically in the primary setting, all patients were still considered to have received appropriate treatment, but, the use of an image-reviewing algorithm will enhance the specificity of CT in the diagnosis of frontobasilar fractures.
Assuntos
Algoritmos , Ossos Faciais/lesões , Tomografia Computadorizada Multidetectores/estatística & dados numéricos , Fratura da Base do Crânio/diagnóstico por imagem , Fraturas Cranianas/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dissecação da Artéria Carótida Interna/diagnóstico por imagem , Estudos de Coortes , Estudos Transversais , Seio Etmoidal/lesões , Ossos Faciais/diagnóstico por imagem , Feminino , Osso Frontal/diagnóstico por imagem , Osso Frontal/lesões , Humanos , Masculino , Fraturas Maxilares/diagnóstico por imagem , Pessoa de Meia-Idade , Osso Nasal/diagnóstico por imagem , Osso Nasal/lesões , Fraturas Orbitárias/diagnóstico por imagem , Osso Esfenoide/diagnóstico por imagem , Osso Esfenoide/lesões , Seio Esfenoidal/diagnóstico por imagem , Seio Esfenoidal/lesões , Adulto JovemRESUMO
A 31-year-old man with epiphora and mucous discharge from a traumatic lacrimal fistula underwent a computed tomographic dacryocystogram, revealing a fistula extending from the anterior ethmoid air cells through the lacrimal sac to the overlying skin with coexisting nasolacrimal duct obstruction. Endoscopic dacryocystorhinostomy enabled complete marsupialization of the lacrimal sac and agger nasi air cell, removing the tract between these structures. Simultaneous probing of the common canaliculus and fistula tract under direct visualization allowed the identification of the internal fistula origin in relation to the internal ostium on the lateral sac wall. The fistula was excised with a trephine over a guide wire via an external approach. Use of the endoscopic technique for excision of acquired lacrimal fistulas may be especially helpful in cases with coexisting nasolacrimal duct obstruction where the fistula extends to the sinus cavity or suspected foreign bodies.
Assuntos
Fístula Cutânea/cirurgia , Dacriocistorinostomia , Seio Etmoidal/cirurgia , Ferimentos Oculares Penetrantes/cirurgia , Doenças do Aparelho Lacrimal/cirurgia , Aparelho Lacrimal/lesões , Doenças dos Seios Paranasais/cirurgia , Adulto , Fístula Cutânea/diagnóstico por imagem , Endoscopia , Seio Etmoidal/diagnóstico por imagem , Seio Etmoidal/lesões , Ferimentos Oculares Penetrantes/diagnóstico por imagem , Humanos , Doenças do Aparelho Lacrimal/diagnóstico por imagem , Masculino , Doenças dos Seios Paranasais/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
PURPOSE: The surgical approach to the medial orbit allows superior exposure of the medial orbital wall and nasal bones, extending to the orbital apex, with excellent cosmetic results. METHODS: This is a retrospective database study of all patients (N = 98) undergoing a transcutaneous medial canthal tendon incision in practice during 2009. This 1.5- to 2.0-cm incision is made just anterior to, in the same plane as, and shaving the anterior ramus of the medial canthal tendon. After exposing the origin of the anterior ramus of the medial canthal tendon, the periorbita along with the attached medial canthal tendon is elevated, exposing the entire medial orbital wall from the orbital strut to the trochlea. Anterior dissection allows access to the nasal bones to the dorsum of the nasal bridge. The parameters studied in this report were the complication rates (including scarring requiring revision, telecanthus, diplopia related to the technique, and injury to the optic nerve or other orbital structures) and photographic evidence of the final cosmetic result of this approach. RESULTS: During 2009, 173 surgical procedures were performed through the transcutaneous medial canthal tendon incision. The procedures comprised 89 fracture repairs of the nasal or ethmoid complex, 2 naso-orbito-ethmoid fracture repairs, 4 cases of isolated nasal fracture repair, 37 medial wall decompressions for ophthalmic Graves disease, 13 cases of subperiosteal abscess drainage, and 28 dacyrocystorhinostomies using a slightly modified incisional position. The inferior oblique was not cut or released in any of these cases. There were no observed cases of medial canthal webbing, injury to orbital structures, telecanthus, optic neuropathy, or iatrogenically induced diplopia related to the technique. By definition, the authors' follow-up time is limited to less than 2 years in each case; however, all complications, which the authors have considered for this report, would have been readily observable in this postoperative period. CONCLUSIONS: The small incision, transcutaneous medial canthal approach offers excellent and safe exposure of the medial wall, nose, and the orbital apex. The authors differentiate this transcutaneous medial canthal tendon incision from the less cosmetically acceptable, larger and more anterior Lynch incision. This medial canthal tendon incision has, and continues to be, a workhorse in the authors' approach to the medial orbit and nose while offering unparalleled exposure with an excellent safety and complication profile.
Assuntos
Seio Etmoidal/lesões , Pálpebras/cirurgia , Procedimentos Cirúrgicos Oftalmológicos , Fraturas Orbitárias/cirurgia , Seios Paranasais/lesões , Fraturas Cranianas/cirurgia , Tendões/cirurgia , Procedimentos Cirúrgicos Dermatológicos , Humanos , Estudos RetrospectivosRESUMO
OBJECTIVES: To clarify the occurrence, sites, and types of associated injuries in paediatric patients with fractures of the anterior skull base. STUDY DESIGN: Retrospective analysis of files of 49 patients aged up to 18 years. RESULTS: Associated injuries were observed in 91.8% of the patients. Observed most frequently were fractures of the skull vault (85.7%), brain injury (59.2%), facial fracture (42.9%), lung contusion (18.4%) and fractures of the upper extremities (14.3%). Multiple injuries were observed in 55.1% and polytrauma in 42.9%. The mortality rate was 10.2%. CONCLUSIONS: Paediatric patients with fractures of the anterior skull base frequently present with associated injuries, with many having, multiple associated injuries including polytrauma. These patients should be treated in multidisciplinary trauma units.
Assuntos
Base do Crânio/lesões , Fraturas Cranianas/epidemiologia , Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Lesões Encefálicas/epidemiologia , Criança , Pré-Escolar , Contusões/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Seio Etmoidal/lesões , Ossos Faciais/lesões , Traumatismos Faciais/epidemiologia , Feminino , Seguimentos , Seio Frontal/lesões , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Lesão Pulmonar/epidemiologia , Masculino , Traumatismo Múltiplo/epidemiologia , Lesões do Pescoço/epidemiologia , Fraturas Orbitárias/epidemiologia , Estudos Retrospectivos , Osso Esfenoide/lesões , Suíça/epidemiologia , Extremidade Superior/lesõesRESUMO
A 28-year-old woman was shot in the face with an air gun while driving a car. The patient was examined in the Department of Forensic Medicine in Katowice. An inconspicuous scar was found near the medial angle of the right eye. Further ophthalmological and radiological examinations revealed the presence of small foreign bodies in the vitreous body of the right eye, the sphenoid sinus and the ethmoid cells. The authors issued an expert opinion, in which they stated that the sustained injuries had not caused any significant organ dysfunction.
Assuntos
Ar , Corpos Estranhos/diagnóstico , Ferimentos por Arma de Fogo/diagnóstico , Adulto , Seio Etmoidal/lesões , Feminino , Corpos Estranhos/etiologia , Medicina Legal , Humanos , Seio Esfenoidal/lesões , Corpo Vítreo/lesões , Ferimentos por Arma de Fogo/complicaçõesRESUMO
OBJECTIVE: The objectives of the study were to evaluate the clinical characteristics of cerebrospinal fluid (CSF) leaks and determine the clinical parameters affecting endoscopic repair of CSF leaks of the anterior and central skull base. MATERIALS AND METHODS: A retrospective study was undertaken to analyze the clinical characteristics of 28 patients who underwent endoscopic treatment of sinonasal CSF leaks between 2002 and 2009. RESULTS: The causes of sinonasal CSF leaks were traumatic (n = 27) and spontaneous (n = 1). The sites of CSF leaks included the frontal sinus and frontal recess (n = 9), ethmoid sinus (n = 9), sella and clivus (n = 6), and sphenoid sinus (n = 4). The success rate at first-attempt endoscopic repair was 86% (24/28). Cerebrospinal fluid leaks from the frontal sinus/recess had a high failure rate (44% [4/9]). Recurrent frontal CSF leaks were successfully salvaged by an open-endoscopic approach. The final success rate at second attempt was 93% (26/28). Among the variables affecting initial endoscopic success, the location of CSF leak and direct visualization were significant factors (P = 0.008 and 0.018, respectively [Fisher exact test]). No postoperative complications were noted. CONCLUSIONS: Our results showed that endoscopic repair of sinonasal CSF leaks is an effective treatment with a success rate of 93%. Open-endoscopic repair of frontal CSF leaks is feasible in treating endoscopic failures of frontal CSF leaks.
Assuntos
Rinorreia de Líquido Cefalorraquidiano/cirurgia , Endoscopia/métodos , Nariz/lesões , Seios Paranasais/lesões , Tecido Adiposo/transplante , Adolescente , Adulto , Idoso , Vazamento de Líquido Cefalorraquidiano , Criança , Pré-Escolar , Seio Etmoidal/lesões , Seio Etmoidal/cirurgia , Estudos de Viabilidade , Feminino , Seguimentos , Retalhos de Tecido Biológico , Seio Frontal/lesões , Seio Frontal/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Nariz/cirurgia , Seios Paranasais/cirurgia , Recidiva , Reoperação , Estudos Retrospectivos , Sela Túrcica/lesões , Sela Túrcica/cirurgia , Seio Esfenoidal/lesões , Seio Esfenoidal/cirurgia , Cirurgia Assistida por Computador , Retalhos Cirúrgicos , Resultado do Tratamento , Adulto JovemRESUMO
The purpose of this study was to explore the conservative management for an unusual case of transnasal intracranial injury. A 3-year-old female child presenting with transnasal injuries after a domestic accident whereby she apparently fell while holding a large pair of scissors, which then penetrated her left nasal cavity, piercing her nasal cavity, ethmoid sinus, and skull base. The scissors were removed from her nasal cavity. The patient had scant cerebrospinal rhinorrhea and no other additional neurologic deficits noted at the time, as well as no long-term developmental deficits. This report highlights the occurrence of this rare condition. The role of radiologic studies such as computed tomographic scans and plain films in diagnosis and management of this case is affirmed. The strategy of minimally invasive treatment of this injury can be a reasonable treatment option.
Assuntos
Seio Etmoidal/lesões , Corpos Estranhos/complicações , Cavidade Nasal/lesões , Ferimentos Penetrantes/terapia , Acidentes por Quedas , Pré-Escolar , Seio Etmoidal/diagnóstico por imagem , Feminino , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Humanos , Cavidade Nasal/diagnóstico por imagem , Radiografia , Base do Crânio/diagnóstico por imagem , Base do Crânio/lesões , Fraturas Cranianas/diagnóstico por imagem , Fraturas Cranianas/terapia , Resultado do Tratamento , Ferimentos Penetrantes/diagnóstico por imagemRESUMO
CONCLUSION: A cone beam tomography (CBT) examination of the olfactory area with its different variants allows development of an individual anatomical-radiological risk profile of the ethmoid and the identification of so-called 'dangerous ethmoids.' OBJECTIVE: Preoperative imaging performed with high-resolution CBT is imperative for analysis of the risk of injuring the olfactory fossa during sinus surgery. This study aimed to analyze the relevant parameters. METHODS: This was a retrospective, single-center study of 141 patients. The Accu-I-Tomo F17 was used. Keros type, the point of the anterior ethmoid artery, and the angle between the lateral lamella and the cribriform plate (α(lc)) were evaluated. RESULTS: The Keros types were distributed as follows: type I, 13% (α(lc): 131°); type II, 64% (α(lc): 116°); type III, 23% (α(lc): 108°) (p < 0.001). The angle of the olfactory fossa and the position of the anterior ethmoid artery (free course: α(lc)=112° vs integrated into the skull base: α(lc)= 120°) was significantly different. DISCUSSION: Surgical procedures in Keros type III where the height of the lateral lamella is much longer than in type II or type I, with an angle of nearly 107° between the lateral lamella and the cribriform plate, are expected to be safer in comparison with Keros type II with 116° and Keros type I with 131°.