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Holtmann C, Roth MB, Lanzman RS, Turowski B, Antoch G, Mackenzie CR, Borrelli M, Geerling G. [Diagnostics and treatment of organic intraorbital foreign bodies]. DIE OPHTHALMOLOGIE 2023; 120:734-739. [PMID: 36534169 DOI: 10.1007/s00347-022-01785-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/27/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Orbital injuries with organic foreign bodies are a clinical challenge as they can cause a variety of complications and sometimes lead to irreversible visual impairment. MATERIAL AND METHODS We report five consecutive cases of patients with organic orbital foreign bodies who presented between 2012 and 2022. Documented parameters include age, gender, time of injury, mechanism of injury, best-corrected visual acuity (BCVA), presence of pain, restriction of motility, performed imaging, location and type of foreign body, treatment and complications. RESULTS The mean patient age was 61.8 ± 32.3 years and the gender ratio was 4:1 (female:male). In 4 cases the injury had been reported on average 4.6 days (0/14 days min/max) previously. Best corrected visual acuity at first presentation was 0.5 ± 0.2 decimal and after a mean follow-up of 12.7 months (0.5/38 months min/max) at last presentation 0.67 ± 0.3 decimal (p = 0.2). The reason for initial presentation was pain (n = 3) and/or double vision (n = 2). All patients underwent computer tomography (CT). The diagnosis was confirmed in two cases by means of CT. In all five cases the foreign body material could be completely surgically removed, while one patient needed repeated surgery due to retained foreign body material. The organic foreign body material included wood (4) and wax (1). In two cases, a foreign body-induced infection was successfully treated with systemic antibiotics. There were no other complications. CONCLUSION In orbital trauma a thorough wound exploration must be performed, especially if the mechanism of injury is uncertain and residual foreign bodies or a perforation injury cannot be excluded. The imaging of choice is CT, which may have to be performed again in the postoperative course.
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Affiliation(s)
- Christoph Holtmann
- Medizinische Fakultät, Klinik für Augenheilkunde, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland.
| | - Mathias B Roth
- Medizinische Fakultät, Klinik für Augenheilkunde, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Rotem S Lanzman
- Medizinische Fakultät, Institut für Diagnostische und Interventionelle Radiologie, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Bernd Turowski
- Medizinische Fakultät, Institut für Diagnostische und Interventionelle Radiologie, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Gerald Antoch
- Medizinische Fakultät, Institut für Diagnostische und Interventionelle Radiologie, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Colin R Mackenzie
- Medizinische Fakultät, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
- Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Maria Borrelli
- Medizinische Fakultät, Klinik für Augenheilkunde, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
| | - Gerd Geerling
- Medizinische Fakultät, Klinik für Augenheilkunde, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland
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You YY, Shi BJ, Wang XY, Chen J, Wang ZR, Wang XH, Jiang FG. Intraorbital wooden foreign bodies: case series and literature review. Int J Ophthalmol 2021; 14:1619-1627. [PMID: 34667741 DOI: 10.18240/ijo.2021.10.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Intraorbital wooden foreign bodies (IOWFBs) constitute a relatively rare ocular trauma, which occupy a special type of intraorbital foreign bodies (IOFBs). Data regarding IOWFBs must be obtained from case reports or small case series due to their rarity. Here, we reported 5 cases of IOWFBs and reviewed the related literatures, which could provide comprehensive information regarding the clinical manifestations, diagnosis, and surgical treatment of IOWFBs. Combined with the published literature, a total of 51 independent cases were counted after we added 5 cases. Among them, the number of male and female patients was 35 and 16 respectively; the mean age was 27.3±18.2 (range 1-66)y. Obviously, the disorder seemed to occur mainly in young and middle-aged people. Because of the diversity in the clinical manifestations and imaging characteristics of IOWFBs, misdiagnosis and missed diagnosis often occur during the initial visit. Delayed diagnosis may lead to a high risk of orbital infection caused by IOWFBs. Surgery is the treatment of choice for most patients; however, the missed diagnosis and residue of foreign bodies after previous surgery cannot be ignored. Therefore, an accurate diagnosis is governed by the detailed trauma history, careful ocular examination, close observation of clinical manifestations, correct imaging diagnosis [e.g., magnetic resonance imaging (MRI) or computerized tomography (CT)], and timely and completely elimination of IOWFBs.
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Affiliation(s)
- Ya-Yan You
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Bing-Jie Shi
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xin-Yan Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Jin Chen
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Zheng-Rong Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Xing-Hua Wang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
| | - Fa-Gang Jiang
- Department of Ophthalmology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
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Overlooked Piece of Wood Served as a Vector Transmitting Clostridium Perfringens: A Case Report Emphasizing the Awareness of Gas-Forming Organisms in Posttraumatic Pneumocephalus. J Craniofac Surg 2021; 32:e485-e487. [PMID: 33464773 DOI: 10.1097/scs.0000000000007445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT The radiological depiction of posttraumatic pneumocephalus is due to trapped air in most cases. Although rarely reported, it can also be the result of a gas-forming organism, requiring immediate treatment due to high mortality. Here, we report on an elderly patient with radiological appearance of posttraumatic intracranial pneumocephalus after a wound was closed without recognition of a retained tree branch. The piece of wood served as a vector for transmission of Clostridium perfringens causing the collection of abnormal intracranial air. Radical excision of temporal muscle tissue along with extensive evacuation of the brain abscess and targeted intravenous antibiotics resulted in minor morbidity.Although a piece of wood can easily be missed with current diagnostic imaging, it is crucial that both clinicians and radiologists are aware of the presence of air and its differential diagnosis in posttraumatic pneumocephalus, in order to allow timely treatment in this fatal disease.
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Modaboyina S, Agrawal S, Khan R, Bhari A. Intraorbital wooden foreign body, legacy of a notorious scrap: a case report. BMJ Case Rep 2021; 14:14/4/e242885. [PMID: 33858912 PMCID: PMC8055107 DOI: 10.1136/bcr-2021-242885] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Wooden foreign bodies are notorious to be fragile and get retained as bits and bobs in the orbit. A 50-year-old woman presented to casualty with complaints of loss of vision and pain in the right eye associated with discharge from a wound in right eye upper lid. On imaging, a wooden foreign body was seen as continuous track of air. Meticulous dissection and search were done to remove bits and bobs of the wood. Patient, however, after 15 days of primary surgery reported with pus collection over wound site. Keeping suspicion of remnant wooden body piece(s), imaging and further exploration were carried out, removal of a 1 cm residual wooden piece was done. Retained wooden foreign body should always be suspected in postoperative cases of intraorbital wooden foreign body with infection. A close follow-up and knowledge of the same stay useful to remove any needless apprehension both of patient and surgeon.
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Affiliation(s)
- Sujeeth Modaboyina
- Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Delhi, India
| | - Sahil Agrawal
- Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, AIIMS, Delhi, India
| | - Ragib Khan
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Anju Bhari
- Opthalmology, All India Institute of Medical Sciences, Delhi, India
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Jabang JN, Dampha L, Sanyang B, Roberts CA, Ceesay B. Management of a large intraorbital wooden foreign body: Case report. Surg Neurol Int 2020; 11:158. [PMID: 32637211 PMCID: PMC7332514 DOI: 10.25259/sni_204_2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/21/2020] [Indexed: 11/12/2022] Open
Abstract
Background: Intraorbital foreign bodies are a global injury and occur with a frequency of one in six orbital injuries; however, intraorbital wooden foreign bodies are uncommon. Intraorbital wooden foreign bodies predominantly affect the male population with a mean age ranging from 21 to 22 years. The diagnosis of intraorbital wooden foreign bodies depending on their size can be challenging on imaging and if not removed early the risk of infection is high. Case Description: A 23-year-old motorcyclist presented to the ER following a collision with a donkey cart carrying wood 3 h before presentation. Examination revealed an acutely ill-looking man in painful distress with a right supraorbital laceration associated with ipsilateral ptosis and periorbital edema. There was a retained intraorbital wooden foreign body. Computed tomography scan showed evidence of both an intraorbital bone fragment and a wooden foreign body. Surgery was done 3rd day of admission before which vision has declined with only perception to light. Only the wooden foreign body was removed. Evolution was favorable with recovery of vision and improvement of the ptosis. Conclusion: The management of intraorbital wooden foreign bodies demands a multidisciplinary approach after a thorough history, examination, and imaging. Treatment of choice is timely and meticulous removal of the foreign body to avoid infection and other associated complications.
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Affiliation(s)
- John Nute Jabang
- Neurosurgery Unit, Department of Surgery, Edward Francis Small Teaching Hospital
| | - Lamin Dampha
- Neurosurgery Unit, Department of Surgery, Edward Francis Small Teaching Hospital
| | - Binta Sanyang
- Neurosurgery Unit, Department of Surgery, Edward Francis Small Teaching Hospital
| | | | - Bakary Ceesay
- Opthalmology Unit, Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia
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Del Verme J, Giordan E, Marton E, Zanata R, Di Paola F, Canova G, Longatti P. Classification of orbitocranial wooden foreign body penetration injuries: what to do when they violate the intracranial space? A systematic review. J Neurosurg Sci 2019; 64:190-199. [PMID: 31738026 DOI: 10.23736/s0390-5616.19.04793-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Orbitocranial wooden foreign body (OWF) penetrations are rare but challenging occurrences that may violate the intracranial space resulting in brain damage and hemorrhagic, as well as infectious, complications. Moreover, there is a specific subset of cases of OWF penetrations that are particularly challenging to treat. Although there are well-defined management guidelines for pure intraorbital localization, there is not yet a defined treatment protocol for foreign bodies reaching the intracranial space. However, their removal performed either directly or through craniotomy, is often easily attainable given the condition that all necessary precautions are accounted for. EVIDENCE ACQUISITION After having treated a 48-year-old man with a transorbital OWF penetration injury at our neurosurgical department, we systematically reviewed the last 15 years of literature to define and summarize the best management strategy. Multiple databases were searched for case reports and case series involving patients with intraorbital and transorbital OWF penetration injuries. For each study, we extracted data on age, sex, imaging modality, type of wood (processed vs. unprocessed), location of periorbital and intracranial entry site, treatment type ("pull and see" or "open and see"), antibiotic therapy, and complications. EVIDENCE SYNTHESIS We classified transorbital OWFs into two categories: transorbital with only cavernous sinus involvement and transorbital with more extensive intracranial involvement. We described what we believed was the most appropriate management conduct in each case. CONCLUSIONS Grounded on our experience and on the review of the literature, we suggest, based on the anatomical localization of the OWF, a classification system for OWFs which is coupled with a tailored treatment strategy for each case. These suggestions are made to provide surgeons with direction on the correct management of such rare but challenging occurrences.
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Affiliation(s)
- Jacopo Del Verme
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy
| | - Enrico Giordan
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy -
| | | | - Roberto Zanata
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy
| | | | - Giuseppe Canova
- Department of Neurosurgery, Aulss 2 Marca Trevigiana, Treviso, Italy
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Braig EM, Birnbacher L, Schaff F, Gromann L, Fingerle A, Herzen J, Rummeny E, Noël P, Pfeiffer F, Muenzel D. Simultaneous wood and metal particle detection on dark-field radiography. Eur Radiol Exp 2018; 2:1. [PMID: 29708215 PMCID: PMC5909361 DOI: 10.1186/s41747-017-0034-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 11/28/2017] [Indexed: 11/23/2022] Open
Abstract
Background Currently, the detection of retained wood is a frequent but challenging task in emergency care. The purpose of this study is to demonstrate improved foreign-body detection with the novel approach of preclinical X-ray dark-field radiography. Methods At a preclinical dark-field x-ray radiography, setup resolution and sensitivity for simultaneous detection of wooden and metallic particles have been evaluated in a phantom study. A clinical setting has been simulated with a formalin fixated human hand where different typical foreign-body materials have been inserted. Signal-to-noise ratios (SNR) have been determined for all test objects. Results On the phantom, the SNR value for wood in the dark-field channel was strongly improved by a factor 6 compared to conventional radiography and even compared to the SNR of an aluminium structure of the same size in conventional radiography. Splinters of wood < 300 μm in diameter were clearly detected on the dark-field radiography. Dark-field radiography of the formalin-fixated human hand showed a clear signal for wooden particles that could not be identified on conventional radiography. Conclusions x-ray dark-field radiography enables the simultaneous detection of wooden and metallic particles in the extremities. It has the potential to improve and simplify the current state-of-the-art foreign-body detection.
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Affiliation(s)
- Eva-Maria Braig
- 1Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany.,2Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 München, Germany
| | - Lorenz Birnbacher
- 1Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany
| | - Florian Schaff
- 1Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany
| | - Lukas Gromann
- 1Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany
| | - Alexander Fingerle
- 2Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 München, Germany
| | - Julia Herzen
- 1Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany
| | - Ernst Rummeny
- 2Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 München, Germany
| | - Peter Noël
- 1Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany.,2Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 München, Germany
| | - Franz Pfeiffer
- 1Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany.,2Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 München, Germany.,3Institute for Advanced Study, Technical University of Munich, 85748 Garching, Germany
| | - Daniela Muenzel
- 2Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Straße 22, 81675 München, Germany
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Yao Y, Shen F, Chen A, Ying G, Zhu Y. Percutaneous endoscopic removal of a residual foreign body at the orbital-cranial region after transorbital penetrating injury: a novel minimally invasive technique. Chin Neurosurg J 2017. [DOI: 10.1186/s41016-017-0102-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Lee SB, Lee RK, Suh JH, Choi JW, Ha CY, Kang C. A Case of Wooden Foreign-Body Ingestion. J Emerg Med 2017; 54:121-123. [PMID: 29107480 DOI: 10.1016/j.jemermed.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/10/2017] [Accepted: 09/14/2017] [Indexed: 01/08/2023]
Affiliation(s)
- Sang Bong Lee
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ryun Kyung Lee
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Ja Hyoen Suh
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Jung Woo Choi
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Chang Yoon Ha
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Changwoo Kang
- Department of Emergency Medicine, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital, Jinju, Republic of Korea
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