An intraorbital foreign body with paradoxical radiological interpretations to dive in or not? a surgeon’s dilemma

A 10-year-old girl presented to our O.P.D. with intra-orbital trauma. On radiological workup following admission, USG B Scan, MRI Brain and 3D reconstructed faciomaxillary imaging were indeterminate for presence of foreign body, whereas CT scan showed a hyperdense lesion suggestive of intra-orbital foreign body. In this condition of imaging dilemma, surgical exploration was decided since there was no improvement in clinical symptoms via lateral orbital approach. Two small wooden pieces were detected in orbital exploration. This case highlights the role of history taking, clinical judgement in all cases of intraorbital tumour more so in paediatric population than solely going by the investigative modalities.

Management experience of severe wooden foreign bodies injuries in head and neck region / 口腔疾病防治

Objective@# To describe our experience with the surgical treatment of severe wooden foreign body (WFB) injuries in the head and neck region.@*Methods @#A case series review of WFB injuries in the head and neck region that were managed at Sun Yat-sen Memorial Hospital between 2008 and 2014 was performed retrospectively. The clinical findings and surgical details of ten cases were reviewed. @*Results @#The WFBs were integrally removed from all patients with the average age of 40.9 years. 8 cases dued to falling and 2 cases because of industrial injuries. All cases under-went general anesthesia (6 cases tracheal incision, 3 cases through nose intubation, 1 cases through oral intubation).The lengths of the WFBs ranged from 4.0 cm to 17.5 cm (average 9.96 cm). The procedures lasted 30 to 180 min. No se-vere bleeding was observed. Total blood loss ranged from approximately 3 to 200 mL (average 69 mL). The patients were followed for 11 to 38 months, and no postoperative complications, only 1 cases appeared open type deviation and 2 cases of scar discomfort after neck operation. @*Conclusion @#Surgical treatment of severe WFB injuries in the head and neck region is acceptably safe and effective. Endoscopic surgery can be used in patients with WFBs that are embedded in the maxilla.

Chronic brain abscess secondary to a retained wooden foreign body: Diagnostic and management dilemmas.

A four-year-old child presented with recent onset generalized tonic clonic seizures. She was operated for a suspected intracranial tuberculoma and was found to harbor an intra-parenchymal retained wooden foreign body with a chronic abscess. The foreign body had entered the brain parenchyma after a minor head injury, sustained three years earlier. She was asymptomatic for the intervening three years. The initial diagnosis was missed by several physicians. A retained wooden fragment via a transtemporal apparently closed head injury is an extremely rare event. The present study reveals the diagnostic and therapeutic challenges and stresses the importance of high degree of suspicion to diagnose retained intracranial foreign bodies and the need for early surgical exploration, to avoid chronic and potentially life threatening neurological complications.

Wooden Foreign Body in the Parotid Gland

PURPOSE: Now the CT scanner and PACS program proved to be an excellent instrument for detection and localization of most facial foreign bodies above certain minimum levels of detectability. The severity of injury in penetrating trauma on the face is often underestimated in physical examination. Wood, with its porous consistency and organic nature, provides a good medium for microbial agents. This is a report of our recent experience with wooden foreign bodies in the parotid gland imaged with CT. METHODS: A 9-year-old boy was referred for evaluation of possible retained foreign body within his face. One day earlier, he had fallen, face down approximately 1 miter onto ground. He had subsequently undergone an exploration of his right parotido-masseteric area at an outside hospital with repair of a right facial laceration. Enhanced 2 mm axial and coronal CT scans were obtained through the face. Axial and coronal CT images were obtained with a General Electric(Milwaukee, Wis) 9800 CT scanner at 130kV, 90mA, with a 2mm section thickness. RESULTS: We finally decided the linear "gas" attenuation was a foreign body because of its linear configuration, which did not conform to that of an anatomic structure, and on the basis of articles that described a wood foreign body in the orbit as having the appearance of air. We found that wood was hypoattenuating(-464+/-27HU). CONCLUSION: We recommend this type of software program for CT scanning for any patient with an injury on the face in which a foreign body is suspected.

A Case of Retained Multiple Intraorbital Foreign Bodies

PURPOSE: A diagnosis of wooden intraorbital foreign bodies is common and their removal is often necessitated after complications become manifested. In case of operation, it is difficult to find and remove wooden foreign bodies completely. We have experienced a case of retained multiple intraorbital foreign bodies removed by the secondary operation. We report this case with a literature review. METHODS: A 39-year-old man visited our clinic complaining of diplopia, exophthalmos, and limitation of eyeball movement. He had fallen down and had a lacerated wound. Right after primary closure, he experienced strabismus, orbital cellulitis, and abscess. Several months later, he had a soft mass in the operated lower lid, and two wooden intraorbital foreign bodies were found. MRI detected granuloma and cellulitis near the cavernous sinus. RESULTS: More than ten intraorbital wooden foreign bodies were surgically removed. After the surgery exophthalmos and diplopia were improved, and limitation of eyeball movement disappeared. The MRI findings were also improved. CONCLUSIONS: Intraorbital wooden foreign bodies should be diagnosed with a thorough history taking and radiologic exam, due to a number of potential complications, such as orbital cellulitis, abscess, and diplopia. Furthermore, they should be removed in consideration that they can move spontaneously into the deep interior of the orbit.

A case of retained wooden foreign body in orbit

A 41-year-old man visited our clinic complaining of esodeviation of the right eye. He had been operated on for corneal laceration 3 years before. One month later, exodeviation of the right eye had developed. The result of computed tomography (CT) was reported as orbital abscess and cellulitis. Although antibiotic treatment was administered for 2 weeks, the exodeviation didn't improve. On ocular examinations performed in our hospital in November-2001, his right eye was esotropic and had a relative afferent pupillary defect. Vision of the right eye was decreased to 0.02. Fundus examination showed optic atrophy. A new CT scan disclosed a foreign body introduced into the right medial orbital wall, nasal cavity and ethmoidal sinus. Although foreign body was surgically removed, vision and eye movement were not improved. In the case of a patient who has undergone orbital trauma, complete history taking and physical examinations must be performed. On suspicion of a foreign body, imaging study such as CT or MRI must be performed. However, because CT findings can be variable, careful follow-up is needed.

A Case of Penetrating Cranial Injury by a Wooden Foreign Body

Many objects create penetrating cranial injuries. Metallic objects and low velosity missiles are the most common offenders. Wood as wounding agent of the brain, has some characteristics. It has profound risk of infection, a significant propensity to fragmentation that is virtually undetechable on routine X-ray screening and very low atteunation value in CT scan. Because of its characteristics and rarity, we report a case of penetrating cranial injury by a wooden foreign body with review of literature.