Injury to the Temporal Lobe via Medial Transorbital Entry of a Toothbrush

A Rare Case of Craniocervical Penetrating Injury by a Steel Bar

Rationale

Non-missile penetrating injuries caused by foreign bodies, such as knives or sharp wood, are infrequent. We report a 49-year-old male suffering from severe craniocervical penetrating injury by a steel bar was successfully treated by surgery.

Chief Complaint

The male patient was a 49-year-old builder. Although working on the construction site, an approximately 60 cm steel bar penetrated the patient's brain vertically through the left top of the head presenting with unconsciousness and intermittent irritability.

Diagnosis

Computed tomography of the head showed the entrance and exit of the skull damaged by the steel bar. Three-dimensional reconstruction showed that the steel bar entered the skull from the posterior left coronal suture and penetrated the ipsilateral occipital bone, about 5 cm into the neck soft tissue.

Intervention

We successfully performed the operation and removed the steel bar.

Outcomes

The patient was followed up for 5 years; muscle strength returned to normal.

Lessons

Penetrating injuries caused by steel bars are rare, which always cause severe intracranial injury combined with peripheral tissue injury, by sharing our experience in the treatment of this rare case, we hope to provide a reference for similar injuries in the future.

Nonmissile penetrating head injury with a wooden table leg: An illustrative case

Penetrating head injuries are relatively uncommon and require a unique approach. This report highlights a previously unreported mechanism of injury with a table leg and the steps required to evaluate and promptly treat the patient.

Transorbital nonmissile penetrating brain injury: Report of two cases

BACKGROUND

Penetrating brain injury (PBI) is an uncommon emergency in neurosurgery, and transorbital PBI is a rare type of PBI. Reasonable surgical planning and careful postoperative management can improve the prognosis of patients

CASE SUMMARY

The first case is a 68-year-old male patient who was admitted to the hospital because a branch punctured his brain through the orbit for approximately 9 h after he unexpectedly fell while walking. After admission, the patient underwent emergency surgical treatment and postoperative anti-infection treatment. The patient was able to follow instructions at a 4-mo follow-up review. The other case is a 46-year-old male patient who was admitted to the hospital due to an intraorbital foreign body caused by a car accident, after which the patient was unconscious for approximately 6 h. After admission, the patient underwent emergency surgical treatment and postoperative anti-infection treatment. The patient could correctly answer questions at a 3-mo follow-up review.

CONCLUSION

Transorbital PBI is a rare and acute disease. Early diagnosis, surgical intervention, and application of intravenous antibiotics can improve the prognosis and quality of life of patients.

Management of Penetrating Skull Base Injury: A Single Institutional Experience and Review of the Literature

BACKGROUND

Penetrating skull base injury (PSBI) is uncommon among head injuries, presenting unique diagnostic and therapeutic challenges. Although many cases of PSBIs have been reported, comprehensive understanding of its initial diagnosis, management, and outcome is still unavailable.

MATERIALS AND METHODS

A retrospective review was performed for patients treated in neurosurgical department of Changzheng Hospital for PSBIs. Presurgical three-dimensional (3D) Slicer-assisted reconstructions were conducted for each patient. Then we reviewed previous literature about all the published cases of PSBIs worldwide and discussed their common features.

RESULTS

A total of 5 patients suffering PSBIs were identified. Penetrating points as well as the surrounding neurovascular structures were clearly visualized, assisting in the presurgical planning of optimal surgical approach and avoiding unexpected vascular injury. Four patients underwent craniotomy with foreign bodies removed successfully and 1 patient received conservative treatment. All of them presented good outcomes after proper management.

CONCLUSION

Careful physical examination and radiological evaluation are essential before operation, and angiography is recommended for those with suspected vascular injuries. 3D modeling with 3D Slicer is practicable and reliable, facilitating the diagnosis and presurgical planning. Treatment decision should be made upon the comprehensive evaluation of patient's clinicoradiological features and characteristics of foreign bodies.

Oral injuries in children presenting to a Japanese pediatric emergency room

BACKGROUND

Oral injuries are common among children, but studies on oral injury according to the presence of foreign objects in the mouth are limited. The aim of this study was to compare injury patterns and their effects in children presenting to a Japanese pediatric emergency room (ER) with and without foreign objects in the mouth.

METHODS

Children who were brought to the ER at Tokyo Metropolitan Children's Medical Center with oral injuries between 1 January 2011 and 31 December 2012, were included. Information regarding mechanism of injury, object related to injury, required procedure, and disposition (i.e. placement after ER evaluation: hospitalization or discharge) was collected. Injured subjects with and without foreign objects in the mouth were compared.

RESULTS

Three hundred and nineteen subjects were included in analysis. Median age was 26 months. Labial mucosa, tongue, buccal mucosa, and teeth were major locations of injury. Tumble (i.e. fall from standing) was the leading mechanism of injury (50%). Seventy-one subjects (22%) were holding foreign objects in the mouth when injury occurred. A toothbrush was the most common object (31%). Subjects with foreign objects in the mouth were more likely to injure the posterior parts of the mouth, and to require imaging (P = 0.04) and hospital admission (P < 0.001). This was also the case for children with injury due to tumble.

CONCLUSIONS

Tumble (i.e. fall from standing) was the most common mechanism of injury. Furthermore, requirement for medical resources increased if children had foreign objects in their mouth. Preventive measures should focus on educating parents about the dangers associated with children moving around while holding objects in the mouth.

Transorbital penetrating brain injury to frontal lobe by a wheel spoke

Penetrating brain injury (PBI) is rare and the severest form of head injury with a high morbidity and mortality. A 3.5-year-old girl presented with PBI with a wheel spoke. Computerized tomography scan with three-dimensional skull reconstruction depicted its extent from the medial side of the roof of the right orbit to the right frontal lobe with a cavitation around the spoke. The spoke was removed by manipulation under general anesthesia from the entry site without a formal craniotomy. Postoperative outcome was uneventful.

Transorbital stab injury with retained knife: a narrow escape

Transorbital penetrating injuries are unusual but may cause severe brain damage if cranium is entered. These kinds of injuries are dangerous as the walls of orbit are very thin, hence easily broken by the otherwise innocent objects. Because of the very critical anatomical area involved, these injuries pose a serious challenge to the physicians who first receive them as well as the treating team. These may present as trivial trauma or may be occult and are often associated with serious complications and delayed sequel. Prompt evaluation by utilizing best diagnostic modality available and timely interference to remove them are the key aspects to avoid damage to vital organs surrounding the injury and to minimize the late complications. We report a case of transorbital assault with a 13 centimeter long knife which got broken from the handle and the blade was retained. The interesting aspect is that there was no neurological deficit on presentation or after removal.