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Boyraz M, Yüce S, Örmeci MT, Botan E. Thrombosis secondary to penetration of internal carotid artery due to soft palate impalement injury: A case report of hemiplegic syndrome and literature review. Int J Pediatr Otorhinolaryngol 2024; 176:111809. [PMID: 38096745 DOI: 10.1016/j.ijporl.2023.111809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/22/2023] [Accepted: 11/25/2023] [Indexed: 01/08/2024]
Abstract
Intraoral injuries are frequently encountered in emergency departments due to children's desire and curiosity to put objects in their mouths. However, forward falls with objects in children's mouths can cause impalement injuries to soft palate, retropharyngeal-peritonsillar, and retromolar tissues, leading to serious morbidity and even mortality. These transoral (soft palate, pharynx-tonsil, retromolar region) penetration injuries can especially result in damage to major vascular structures like the Internal Carotid Artery (ICA) due to their close proximity. Dissection, thrombosis, and subsequent stroke can occur in the delicate ICA as a result. In the presented case, a 3-year-old male child experienced internal carotid artery dissection following penetrating injury with a pen, as demonstrated by imaging studies. A literature review is provided along with the case of this child, who developed a reduction in middle cerebral artery (MCA) flow due to thrombosis in the ICA. The study encompasses all penetrating oropharyngeal traumas reported in individuals aged 0-18 years from 1936 to 2023. A search in PubMed and Google Scholar using keywords such as 'internal carotid artery injury,' 'penetrating trauma,' and 'children' yielded 78 case reports from a pool of 36,000 studies. The analysis excludes injuries in areas like tongue, cheek, gums, lips, and floor of the mouth, post-tonsillectomy injuries, and those from sudden braking vehicles. This review encompasses the evaluation, diagnosis, and treatment of penetrating injuries to the soft palate, pharyngeal wall, tonsil, and retromolar regions.
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Affiliation(s)
- Merve Boyraz
- TR Health Sciences University, Van Training and Research Hospital, Department of Pediatrics, Türkiye
| | - Servet Yüce
- Istanbul University, Istanbul Faculty of Medicine, Department of Public Health, Türkiye.
| | - Mehmet Tolgahan Örmeci
- TR Health Sciences University, Van Training and Research Hospital, Department of Radiology, Türkiye
| | - Edin Botan
- TR Health Sciences University, Van Training and Research Hospital, Pediatric Intensive Care Unit, Türkiye
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Chandran V, Sekar A, Mishra N. Transoral fractureless penetrating injury to brainstem in a child: a rare presentation. Childs Nerv Syst 2022; 38:505-507. [PMID: 35091807 DOI: 10.1007/s00381-022-05455-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Vipin Chandran
- Department of Neurosurgery, AlI India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha,, 751019, India
| | - Arunkumar Sekar
- Department of Neurosurgery, AlI India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha,, 751019, India.
| | - Nitasha Mishra
- Department of Anaesthesia, AlI India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha,, 751019, India
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A case of death of purulent meningitis caused by transorbital intracranial penetrating injury due to long-term residual bamboo chopstick. Leg Med (Tokyo) 2022; 55:102012. [PMID: 34998200 DOI: 10.1016/j.legalmed.2021.102012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 11/20/2022]
Abstract
This article reports a case of death caused by purulent meningitis after a long-term transorbital intracranial penetrating injury induced by a bamboo chopstick. A 53-year-old man was pierced with a bamboo chopstick into the left orbit, and the bamboo chopstick broke off. The man remained conscious after the injury but developed paroxysmal headaches. Multiple computed tomography, computed tomography angiography, and rhinoscopy detections revealed that a puncture tract had formed from the left orbit to the right edge of the brainstem through the skull base. However, there was no apparent brain injury or cerebrovascular rupture, thus excluding the possibility of a retained intracranial foreign body by the neurosurgeon. Therefore, the man only received symptomatic and conservative treatments. Unfortunately, the man was found dead one morning, 13 months later. Autopsy and histopathological examinations revealed that he died of purulent meningitis caused by a long-term residual intracranial bamboo chopstick. A review of the relevant literature regarding the diagnosis, including diagnostic values and limitations of different imaging technologies, and treatment of residual intracranial foreign bodies, revealed that this was a case of misdiagnosis, leading to delayed treatment. This case had an indirect causal relationship between the victim's death and medical treatment. This article provides clinical strategies for diagnosing and treating such cases and a forensic perspective for identifying causes of deaths attributed to medical malpractices.
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Wu Y, Chen T, Yuan M, Mzimbiri JM, Liu Z, Chen Y, Luo X, Chen F, Liu J. Orbitocranial Penetrating Injury With Multiple Vessel Invasion in an Infant: A Case Report and Literature Review. Front Neurol 2020; 11:591431. [PMID: 33281731 PMCID: PMC7689382 DOI: 10.3389/fneur.2020.591431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/19/2020] [Indexed: 01/17/2023] Open
Abstract
Orbitocranial penetrating injury (OPI) with multiple vascular invasions is a rare occurrence. To our knowledge, experience with its clinical treatment is rather limited, especially for infants. This case report describes an infant who fell from a 0.5 m high bed and landed on a toy with a keen-edged plastic rod. The fractured end of the rod was noted at the medial aspect of the left eyelid, and she was experiencing impaired consciousness. Computed tomography showed that the foreign body penetrated the cavernous sinus with internal carotid artery involvement, and compressed the transverse sinus through the cerebellum. Emergency surgery was performed with temporal occlusion of the left common carotid artery. The rod was removed from the orbital side, and bleeding from cavernous sinus region was effectively controlled under direct inspection via a sub-temporal approach. The patient was successfully treated and recovered consciousness after 17 days. This is the first report of successful management of OPI combined with multiple vascular injury in an infant. Herein, we highlight the anatomical imaging features of the injuries and also the individualized strategy concerning vascular invasion.
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Affiliation(s)
- Yun Wu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Tiange Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Meng Yuan
- Center for Experimental Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | | | - Ziyuan Liu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Yilei Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Xiangying Luo
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Fenghua Chen
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
| | - Jinfang Liu
- Department of Neurosurgery, Xiangya Hospital of Central South University, Changsha, China
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Microsurgical confirmation of parenchymal contamination of hair in a pediatric patient with a penetrating head injury. Childs Nerv Syst 2020; 36:857-860. [PMID: 31701279 DOI: 10.1007/s00381-019-04416-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 10/10/2019] [Indexed: 10/25/2022]
Abstract
Penetrating head injuries are rare, but can cause severe morbidity in children. In particular, penetrating head trauma with a wooden foreign body is considered to be likely to cause central nervous system infections because of its porosity and softness. However, actually confirming minute contaminations, such as skin debris or hair, in the brain parenchyma is rare. We report the case of a 2-year-old boy who presented with a penetrating head injury by a chopstick. During surgical removal of the chopstick, intraparenchymal hair contamination was confirmed under a surgical microscope. The postoperative course of the patient was uneventful. After 13 months of follow-up without any infectious events, the patient remains well and asymptomatic. The findings in the present case demonstrate that in the case of a penetrating head trauma with a wooden foreign body, surgical removal and active debridement should be the treatment of first choice.
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Nussbaum ES, Graupman P, Patel PD. Repair of the superior sagittal sinus following penetrating intracranial injury caused by nail gun accident: case report and technical note. Br J Neurosurg 2019:1-5. [PMID: 31220943 DOI: 10.1080/02688697.2019.1630550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report a 45-year-old man who suffered a penetrating nail gun injury resulting in damage to the lateral edge of the superior sagittal sinus. The injury was successfully treated via a parasagittal craniotomy that enabled removal of the nail under direct vision, allowing for rapid suturing of the sagittal sinus. Two neurosurgeons worked together; one carefully withdrew the tip of the nail back into the sinus itself while the second rapidly sutured the hole in the inner superior sagittal sinus leaflet. Postoperatively, the patient made a rapid recovery without neurological deficit.
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Affiliation(s)
- Eric S Nussbaum
- a National Brain Aneurysm & Tumor Center, Department of Neurosurgery , United Hospital , St Paul , MN , USA
| | - Patrick Graupman
- a National Brain Aneurysm & Tumor Center, Department of Neurosurgery , United Hospital , St Paul , MN , USA
| | - Puja D Patel
- b Department of Neuroscience , University of Southern California , Los Angeles , CA , USA
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Daudfar S, Gorman C, Pham JT. Hemiplegic Syndrome After Chopstick Penetration Injury in the Lateral Soft Palate of a Young Child. J Osteopath Med 2018; 118:555-559. [PMID: 30073339 DOI: 10.7556/jaoa.2018.124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Soft palate penetrating injuries have been reported among children, particularly in children falling with objects in their mouth. The authors present a case of a healthy 14-month-old child who fell onto a blunt-ended chopstick, the subsequent cerebrovascular accident, and the role of the osteopathic tenets thereafter. The child had an acute infarction to the region of his right middle cerebral artery secondary to right internal carotid artery occlusion. Physicians should consider the neurologic sequelae of lateral soft palate injuries and damage to the surrounding anatomical structures. A thorough, whole-patient approach to physical examination is critical.
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Drosos E, Giakoumettis D, Blionas A, Mitsios A, Sfakianos G, Themistocleous M. Pediatric Nonmissile Penetrating Head Injury: Case Series and Literature Review. World Neurosurg 2018; 110:193-205. [DOI: 10.1016/j.wneu.2017.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 10/18/2022]
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McKenzie J, Cooper Murphy M, Broome C, Tayari H, Gutierrez-Quintana R. Imaging characteristics and treatment of a penetrating brain injury caused by an oropharyngeal foreign body in a dog. Vet Radiol Ultrasound 2017; 60:E24-E28. [PMID: 28726346 DOI: 10.1111/vru.12527] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 04/13/2017] [Accepted: 04/24/2017] [Indexed: 11/29/2022] Open
Abstract
A 4-year-old Border collie was presented with one episode of collapse, altered mentation, and a suspected pharyngeal stick injury. Magnetic resonance imaging (MRI) and computed tomography showed a linear foreign body penetrating the right oropharynx, through the foramen ovale and the brain parenchyma. The foreign body was surgically removed and medical treatment initiated. Complete resolution of clinical signs was noted at recheck 8 weeks later. Repeat MRI showed chronic secondary changes in the brain parenchyma. To the authors' knowledge, this is the first report of the advanced imaging findings and successful treatment of a penetrating oropharyngeal intracranial foreign body in a dog.
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Affiliation(s)
- Jennifer McKenzie
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Megan Cooper Murphy
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Cameron Broome
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Hamaseh Tayari
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
| | - Rodrigo Gutierrez-Quintana
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH, UK
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Transoral Intracranial Injury via Middle Skull Base by a Blunt Chopstick in a Child. World Neurosurg 2017; 103:952.e11-952.e17. [DOI: 10.1016/j.wneu.2017.04.084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 11/17/2022]
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