Magnetic resonance imaging and computed tomography in a model of wooden foreign bodies in the orbit

Clinical analysis of 96 patients with intraorbital foreign bodies: A 10-year retrospective study

Introduction

To investigate the clinical manifestations, diagnosis, and surgical treatment of intraorbital foreign bodies (IOFBs).

Methods

Patients with IOFBs were enrolled from Wuhan Union Hospital between January 2011 and January 2021. Demographic and clinical information was extracted, including gender, age, cause and entrance of the trauma, material, size and quantity of foreign body, visual function, ocular complications, imaging findings, and surgical intervention. The patients were divided into two groups according to the timeline, group A (from January 2011 to December 2015, n = 39) and group B (from January 2016 to January 2021, n = 57).

Results

The 96 patients (81 men and 15 women) were enrolled in this series, with a median age of 39.5 (1.6–76.0) years. Work-related injuries were the cause of IOFBs in 45 individuals (46.9%). Three patients (3.3%) presented severe visual impairment, and 39 patients (42.4%) presented blindness. The majority of foreign bodies were metal (44.8%), followed by wood (26.0%). Computed tomography (CT) and magnetic resonance imaging (MRI) were performed, respectively, on 89 (92.7%) and 21 (21.9%) patients with IOFBs, in which the detection rate was 80.9% for CT and 81.0% for MRI. Among the 25 patients with intraorbital wooden foreign bodies (IOWFBs), the utilization and detection rates of MRI were 50.0% and 40.0% in group A, and 93.3% and 92.9% in group B, with significant differences in both rates between the two groups (both P < 0.05). The IOWFBs detection rate in MRI was significantly higher than that in CT (78.9% vs. 45.8% overall and 92.9% vs. 53.5% in group B). The detection rates of IOFBs and IOWFBs in initial surgery were statistically different between the two groups, of which the rates were 84.6% and 40.0% in group A and 98.2% and 93.3% in group B. The reoperation rate of IOWFBs in group B (20.0%) was significantly lower than that in group A (70.0%).

Conclusion

IOFBs were mainly caused by work-related injuries and might lead to serious visual impairment. The application and detectability of MRI in IOWFBs improved in recent years, and MRI presented better detectability than CT in diagnosing IOWFBs. Thus, MRI should be recommended despite negative CT findings.

Intraorbital wooden foreign bodies: case series and literature review

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.

Photoacoustic Imaging and Sensing: A New Way to See the Eye

Purpose: Photoacoustics (optoacoustics) is a hybrid technology utilizing light excitation of acoustic responses in targets of interest. It has found numerous applications in biomedicine, including eye research, because of its ability to report both morphological and functional data about the interrogated tissue. This presentation will give an overview of current applications. Methods: Wavelength-dependent absorption of light in a tissue chromophore causes local heating, leading to a thermoelastic expansion-contraction cycle. If nanosecond pulses of light are used to excite this process, the resulting pressure wave is an ultrasound signal propagating through the tissue and detectable at the tissue surface. This is highly advantageous because of the known properties of ultrasound propagation in tissue and the ability to use standard, medical ultrasound equipment for detection. The time of arrival and amplitude of ultrasound signals provide information about the location and nature of the absorber. Results: Due to the wavelength dependence of the photoacoustic response, functional and physiological applications are possible. For example, retinal oximetry can be determined from the different optical absorption properties of oxy- and deoxyhemoglobin. Multispectral imaging of the posterior segment can identify pigments such as melanin or lipofuscin or the nature of foreign bodies. The technique can be combined with other imaging modalities such as ultrasound and optical coherence tomography to produce high-resolution images of retinal structures along with functional information. Conclusion: Photoacoustic technology is a powerful noninvasive tool for ocular research and to study ocular morphology, fundamental physiological parameters, cellular responses, and molecular expression.

Multimodal imaging features of intraocular foreign bodies

Objective: To determine the imaging approach for evaluating intraocular foreign bodies (IOFBs) by comparing the ability of different modalities [plain film x-ray, computed tomography (CT), magnetic resonsance imaging (MRI), convetional ultrasound, and ultrasound biomicroscopy] to detect and characterize IOFBs.Methods & Design: Systematic review of the literature.Results: CT is the most practical first step for evaluating patients with suspected IOFBs because it can detect a wide range of IOFB types at small limitis of detection. MRI and ultrasound are best reserved as adjunctive tests in most cases although these tests may provide important insights especially with wood, plastic, and glass IOFBs. Imaging characteristics of metal, wood, glass, plastic, stone, concrete, and graphite IOFBs are reviewed.Conclusion: Understanding the limits of detection for each IOFB type and imaging modality as well as the characteristic features of different IOFBs is of paramount importance to optimizing the management of ocular trauma patients.

Delayed diagnosis of an intraorbital wooden foreign body

A 35-year-old male patient was presented with pain on his right upper eyelid. A piece of wood injured his orbital and supraorbital regions while working at a furniture factory 10 days prior to our hospital admission. It was learned that the patient was discharged following the primary would closure procedure. Subsequent to the craniofacial computed tomography, primary wound closure was performed in the emergency room of previous hospital. In our clinic, a skin suturing on the nasal side of the right eyebrow was inspected and a foreign body (FB) was palpated on the superonasal contiguity of the patients' right globe. A hyperdense FB measuring 30 × 10 × 5 mm in size with smooth margins on superonasal contour of the globe was detected. Superonasal orbitotomy was performed and the FB was completely removed. Finally, visual acuity was 20/20 and a mild residual ptosis was observed.

Wooden Foreign Bodies in CT

CT findings in 2 patients with a wooden foreign body in the orbital region soft tissue, and a series of CT measurements of wooden elements are presented. The wooden foreign bodies presented low HU numbers in CT and were initially interpreted as a gas collection. Different species of trees presented a large spectrum of densities, varying from the −550 HU of pine up to the +289 HU of ebony. The density of a spruce plank increased along with water-logging from −470 HU to −86 HU in 4 weeks, and peak enhancement up to 106 HU was found in the layer closest to the surface. It was concluded that a wooden foreign body in soft tissues may present CT patterns simulating materials as different as a gas bubble or a bone fragment.

Neurosurgical Management of Nonmissile Penetrating Cranial Lesions

OBJECTIVE

The objective of this study is to present a case series of nonmissile penetrating (NMP) injuries and to establish a workflow for an uncommon mechanism of traumatic head injury through the analysis of each case, classification of the type of lesion, management, and outcome score at follow-up.

METHODS

From January 1991 to December 2008, 36,000 patients presenting with traumatic brain injury (TBI) were admitted in the Department of Neurosurgery, Hospital Antônio Targino, Campina Grande-PB, Brazil. From these patients, 11 presenting with lesions caused by NMP objects were selected.

RESULTS

Among the 11 patients, 9 were men and 2 were women. Their ages ranged from 7 to 74 years old (mean age ± SD, 29.1 ± 22.99 years). All patients underwent neuroradiologic evaluation. The entry point was classified as natural (orbit) or artificial (skull transfixation), and we also divided the patients presenting with secondary parenchymal or vascular damage from those presenting with only lesions caused by the primary penetration into the cranium and meninges. All patients were neurosurgically treated with removal of the foreign body through craniotomy, except the patient whose object (pen) was removed without craniotomy with local anesthesia. Glasgow Coma Scale (GCS) score on admission was a statistically significant factor on prognosis, and any patient who presented with a GCS score of 15 evolved satisfactorily, and there were no deaths in this group of patients (P = 0.04).

CONCLUSIONS

TBIs caused by NMP objects are unusual and caused by aggression, self-inflicted harm (in the case of psychiatric patients), and accident. The foreign body may enter into the skull through a natural hole (orbit, nose, mouth, or ear) or crosses the skull, causing a fracture and creating an artificial hole. Preoperative neuroradiologic assessment is paramount for the correct neurosurgical approach. The main prognostic factor for these patients is the GCS score at admission.

The prevalence of foreign bodies in jaw bones on panoramic radiography

Objective:

Foreign bodies can be deposited in the oral cavity either by traumatic or iatrogenic injury. The most common foreign bodies of iatrogenic origin encountered are restorative materials, like amalgam, and root canal fillings. The aim of this study was to determine the prevalence of foreign bodies detected with panoramic radiography in the jawbones, as well as to evaluate the etiology and characteristics of these pathologies.

Materials and Methods:

From March 2012 to January 2014, 11,144 panoramic radiographs were taken and retrospectively reviewed. The number, characteristics, location of the foreign bodies, age, and gender of the patients were recorded.

Results:

Of the 11,144 patients reviewed, 62 of them have a foreign body with a frequency of 0.6%. The patients who had a foreign body were between 14 and 81 years old. Female patients showed more foreign bodies than male patients. Among the 62 patients, 63 filling materials, one stapler, and five shrapnel were detected. Only 8 patients had symptoms associated with foreign bodies and these foreign bodies excised surgically.

Conclusion:

If possible, these pathologies must be removed at the time of detection to prevent further complications; however, in asymptomatic cases, according to location and the characteristic of the foreign body, they can be kept under observation without performing any operations.

Penetrating Orbital-Cranial Injuries Management in a Limited Resource Hospital in Latin America

Penetrating orbital-cranial injuries (POCIs) are difficult cases especially in hospitals in low-middle-income countries (LMIC) where resources are limited. We present a case series of POCI managed in a university hospital in such scenario. A retrospective case series was conducted including patients with POCI in 2011. Mechanism of injury, Glasgow Coma Scale score, imaging, medical and surgical management, complications, and Glasgow Outcome Scale (GOS) score were analyzed. A total of 30 patients with penetrating orbital injuries were admitted from March 2011 to December 2011. Of this group, only four patients were diagnosed with cranial penetration. Computed tomography (CT) angiography revealed orbital fractures and injury to frontal, temporal, or occipital lobes. Urgent craniotomy with isolation of ipsilateral carotid artery was performed. GOS score at discharge was 5 in three patients and 4 in one patient. POCIs are not uncommon in hospitals of LMIC. In such scenarios, a standard approach with CT angiography and early neurosurgical intervention results in good outcome.

Juxtapontine abscess around a retained wooden fragment following a penetrating eye injury: surgical management via a transtentorial approach

Penetrating injury through the orbit with a retained intracranial wooden foreign body is rare. The authors report the case of a child with a juxtapontine brain abscess secondary to a retained foreign body. The pitfalls in diagnosis and the surgical management for removal of the wooden fragment and drainage of the abscess are discussed.

Wooden intraorbital foreign body injuries: clinical characteristics and outcomes of 23 patients

PURPOSE

To describe the clinical characteristics, interventions, and visual outcomes of orbital injuries associated with wooden foreign bodies.

METHODS

A retrospective case review of orbital injuries managed at Wills Eye Institute and Massachusetts Eye and Ear Infirmary was conducted between 1992 and 2006.

RESULTS

The clinical course and management for a total of 23 intraorbital wooden foreign body injuries were reviewed. The distribution of wood included pencil (39%), tree branch/plant matter (35%), and other treated wood (26%). About half of the subjects (52%) presented with preoperative vision between 20/20 and 20/40. Almost all [corrected] of the subjects with preoperative vision between 20/20 to 20/40 retained vision in that range postoperatively (92%). [corrected] Time from injury to presentation was highly variable, ranging from 24 hours to 17 months (mean, 62 days; median, 3 days). Forty-three percent of subjects presented within 24 hours of injury. The site of foreign body found within the orbit was superior (26%; n = 6), medial 30% (n = 7), inferior (26%, n = 6), posterior (9%; n = 2), and lateral (4%; n = 1). Preliminary radiographic interpretation for foreign body was definite in 61% (n = 14), possible in 22% (n = 5), and absent in 13% (n = 3).

CONCLUSIONS

Young men are at particularly high risk for wood intraorbital foreign body. There was a relatively equal distribution of wood type. The time from injury to presentation was variable, ranging from <1 day to over a year. Almost half of the subjects presented within 24 hours of injury. In patients with a known site of penetration, almost half occurred in the conjunctiva, notably without presence of eyelid laceration, emphasizing the need to check the conjunctiva and fornices closely. Preliminary radiographic readings often miss or are inconclusive in detecting the foreign body. The shape, location, serial examinations, and particularly the use of quantitative CT are extremely helpful in distinguishing retained wood foreign body from other low-density signals of air or fat.

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.

[Diagnosis and therapeutic management of an intraorbital organic foreign body]

INTRODUCTION

Orbital organic foreign bodies are rare and can present different clinical features. The objective of this report is to show the danger of this type of foreign body, present the imaging data, and suggest a diagnostic approach and therapeutic management. We describe three cases of orbital organic foreign bodies with three different clinical presentations.

CASE REPORTS

The first case was a 43-year-old male complaining of a chronic cutaneous fistula of the inferior right eyelid lasting 4 months after an orbital trauma with a wooden object. Two surgeries were necessary to extract the foreign bodies. In the second case, a 37-year-old female with post-traumatic ptosis after a bicycle accident several months before, the imaging exams revealed a fracture of the left orbital ceiling and a superior extraconical foreign body that was removed by a neurosurgery approach. The third case, a 69-year-old male with a right orbit abscess following a trauma with a tree branch had a persistent right orbit inflammation lasting 4 months despite two drainage surgeries and an extraction of an orbital organic foreign body. A third surgery was necessary to completely extract the foreign bodies.

DISCUSSION/CONCLUSION

Detecting an orbital organic foreign body is sometimes difficult, especially when the clinical history is unclear, the ophthalmologic exam reveals no abnormalities, or if the patient is referred to the hospital several months after the traumatic event. Orbital organic foreign bodies can lead to potentially serious orbital or intracranial complications. Computed tomography and orbital ultrasound sometimes do not yield an evocative pattern: for instance, in computed tomography, the low density of wood can be misdiagnosed as air. On the other hand, these foreign bodies can persist in the orbit after several surgical explorations because they can easily break or migrate. Magnetic resonance imaging is useful when an orbital organic foreign body is suspected, but the analysis is easier when clinical data are suggestive.

[Traumatic lesions of the orbit]

Complex and sometimes severe lesions of the orbit can be caused by a variety of injury mechanisms, such as fractures, hemorrhages and foreign bodies. Imaging techniques play an extremely important role in the treatment of various diagnostic question marks, such as direct sequelae of trauma, localization of fractures and soft tissue damage.

Corps étranger intra-orbitaire végétal : à propos d’un cas

A 12-year-old child had left orbital trauma by wood. He consulted 4 months after for orbital cellulitis with cutaneous fistula. The CT scan showed the presence of a left orbital wood foreign body extended to the homolateral cavernous sinus and intracranial. Extraction of the wood fragment associated with an adapted antibiotic treatment led to clinical improvement without visual recovery. A situation of orbital trauma and secondary orbital inflammatory syndrome must raise the suspicion of a foreign body of the orbit and motivate emergency imaging for optimal management of the disorder.

Orbito-cranial injuries caused by penetrating non-missile foreign bodies. Experience with eighteen patients

BACKGROUND

Penetrating non-missile orbito-cranial injuries are uncommon civilian injuries which have some special features. Only limited case-reports are available in the international literature.

METHOD

We present a retrospective review of 18 such in presumed trivial orbital injury. Early identification and removal of retained foreign body fragments was achieved within 36 hours.

FINDINGS

Patients were operated on and followed up for at least of 3 years. The final clinical outcome was excellent: 16 had a Glasgow Outcome Scale (GOS) of 5 while in the remaining 2 it was 4.

CONCLUSION

The present report indicates that good results, in managing such injuries, can be achieved by a high index of suspicion and early diagnosis of intracranial injury in presumed trivial wounds and by the removal of every possible retained foreign body.

[Necrosis and reconstruction of the inferior oblique muscle after removal of a wooden intra-orbital foreign body]

A 39-year-old patient presented 3 days after a bicycle accident with a progressive left periorbital inflammatory swelling and diplopia in upgaze. On the day of the accident, a cranial x-ray did not reveal a fracture or an orbital foreign body, and the 2.5 cm skin wound on the left lower eyelid was sutured. For further evaluation, computer tomography) was performed. This did not show a radio-opaque, orbital foreign body. An explorative orbitotomy was carried out and revealed a 3.7 cm long wooden fragment medial to the inferior oblique muscle (OI). The extraconal portion of OI was found to be necrotic. Complete reconstruction of the OI was not possible due to the extent of the necrosis. The residual muscle was fixated to the orbital septum. Recovery was good and the diplopia resolved after 6 months. This case emphasizes the importance of a meticulous inspection of skin wounds with a high risk of remaining wooden foreign bodies and shows the possibility of functional recovery of extraocular muscles following partial reconstruction.

Intraoperative imaging techniques: A guide to retrieval of foreign bodies

Foreign bodies are frequently introduced into the tissues of the head and neck by various mechanisms, and oral and maxillofacial surgeons are often called upon to retrieve these embedded objects. Retrieval may be quite challenging depending on many factors such as the size of the object, the location, and the surrounding anatomical structures. Preoperative imaging is very important in deciding upon the surgical approach. Computerized tomography is considered the gold standard for detection of foreign bodies because of the ability to localize an object in multiple planes and the creation of a 3-dimensional image. Difficulty arises when looking for a small object in an area with multiple important anatomical structures, such as the infratemporal fossa or the neck. Surgery can become tedious secondary to the risk of postoperative morbidity with injury to various anatomical structures. Foreign bodies in the head and neck are often difficult to manage even when a plan has been formulated from static preoperative images. Intraoperative feedback or guidance, especially when navigating through troublesome locations, can be extremely useful. In this paper, we report 2 cases and discuss the various modalities used for intraoperative imaging as a guide for surgical retrieval of foreign bodies.

Detection of foreign bodies of the head with digital volume tomography

OBJECTIVES

Foreign bodies occur as a sequela of trauma or therapeutic interventions. If the risks are not too high, therapy of choice is the removal of the foreign body. This is only possible if the existence of a foreign body is detected and it is localized accurately.

METHODS

The suitability of digital volume tomography (DVT) for the detection and localization of foreign bodies was investigated. Samples of various materials that are typically found as foreign bodies in the head and neck region were used.

RESULTS

All materials investigated are principally detectable with DVT. Highly radiopaque material was detectable down to small sizes. The detectability of less radiopaque substances like wood and resins was poor when located in soft tissue.

CONCLUSION

DVT is an appropriate tool for the detection of radiopaque foreign bodies. However, foreign bodies made of wood and resin, although detectable by DVT, can be missed when located in muscular tissue. The detectability decreases further when the foreign body is located adjacent to a highly radiopaque tissue like bone. This has to be taken into consideration when using DVT for foreign body detection.

The assessment of ocular injury by ultrasound

Ocular trauma is readily investigated by ultrasound, which is of particular value when the light conducting media are opacified by haemorrhage or other injury. In this situation, direct visualization of the ocular contents by ophthalmoscopy is difficult or impossible. Severe complications are treated by microsurgical techniques, and ultrasound evaluation represents the only practicable method of examination for surgical planning. This review illustrates the grey-scale (B scan or two-dimensional) features of the traumatized eye and describes the examination technique.

Clinical features and management of intraorbital foreign bodies

PURPOSE

To review the clinical features and management of patients with intraorbital foreign bodies.

DESIGN

Noncomparative interventional case series.

PATIENTS AND METHOD

Forty patients seen at two regional orbital surgery departments with intraorbital foreign bodies were reviewed.

MAIN OUTCOME MEASURES

Visual acuity, surgical interventions, and complications.

RESULTS

Seventy-three percent of patients were younger than 30 years old. There were 22 metallic, inorganic; 5 nonmetallic, inorganic; and 13 organic intraorbital foreign bodies (IOrbFb) in this series. Thirty patients were seen at the time of injury, and 10 patients were seen in a delayed setting with orbital complications. Thirty-four patients had surgical removal of their IOrbFb either because of complications or easy surgical access. Six patients had no surgery because of posteriorly located inorganic foreign bodies. Thirteen patients had resultant blind eyes; 12 of these were blind from the initial trauma.

CONCLUSIONS

Loss of vision in conjunction with IOrbFbs is usually a result of the initial trauma. All patients should have antibiotic therapy because of the high incidence of secondary orbital infections. Computed tomography is the best initial mode of imaging. Surgical removal is indicated for all organic IOrbFbs. Inorganic IOrbFbs should be removed if causing complications or if located anteriorly after discussion of potential surgical complications with the patient. Posteriorly located inorganic IOrbFbs should be left alone, unless they are causing significant orbital complications.

Wooden foreign bodies in facial injury: a radiological pitfall

Foreign bodies can present a diagnostic challenge to the maxillofacial surgeon. Three patients, who suffered from a penetrating injury with a wooden foreign body, were examined and treated. Their preoperative CT and MRI scans were evaluated. In an acute case, the penetrating wooden body mimicked air bubbles. In the other two patients, the wood was retained for several months and appeared with a much higher density on CT. In MRI the wooden foreign bodies gave a low signal intensity. In all injuries removal of the foreign body was delayed, because it was initially radiologically missed or misdiagnosed. In the appropriate trauma setting a penetrating wooden body must always be considered. Its attenuation value increases with time as water is absorbed from the surrounding tissues. Although the radiological appearance may show a great variety, CT imaging is the basic diagnostic technique. MRI is the method of second choice.

Transorbital penetrating injury by a chopstick--case report

A one-year-old boy presented with orbitocranial penetrating injury by a chopstick. Neurological examination did not reveal abnormal findings. Skull radiography did not reveal any sign of fracture and there were no abnormal findings. Initially, computed tomography (CT) of the head did not reveal any intracranial lesions. However, bone window CT showed a well-defined low-density abnormality measuring 2.5 cm in length in the right orbit and parasellar region. Magnetic resonance imaging clearly revealed a low-intensity structure extending from the orbit to the prepontine area. Surgical exploration was emergently performed and the wooden fragment was removed. The postoperative course was uneventful. Transorbital penetrating injury by a wooden foreign body is relatively rare. The wound may be superficial and trivial. Major neurological deficit does not usually manifest immediately, so the penetrating injury may be overlooked. If the foreign body is retained in the orbit and cranium, severe infectious complications may occur later.

Orbitocranial penetration by a fern: case report

OBJECTIVE AND IMPORTANCE

Cranial and orbitocranial penetration by organic foreign material is not infrequent. It is important to identify whether penetration has occurred and to localize and remove the organic foreign material.

CLINICAL PRESENTATION

We report a 15-month-old patient who suffered orbitocranial penetration with the stem of a fern. The stem passed through the orbit, exiting via the superior orbital fissure. It continued through the middle cranial fossa to end in the posterior cranial fossa.

INTERVENTION

The patient underwent surgery, and a modified Dolenc procedure was performed. The foreign body was identified in the prepontine cistern and was removed. An extradural approach was performed to the cavernous sinus and superior orbital fissure, and the remaining foreign body was removed.

CONCLUSION

Retained intracranial wood should be removed. The radiological diagnosis can be difficult, and magnetic resonance imaging is the investigation of choice. Magnetic resonance imaging may not detect some cases of organic foreign material penetration.

Bamboo skewer perforation of the bowel: computed tomography appearances

A 25-year-old Chinese woman presented with a painful left-lower-quadrant abdominal mass. Computed tomography (CT) demonstrated a dense forked foreign body within an extraluminal mass. A 2.5 cm bamboo skewer surrounded by inflamed omentum was found at laparotomy. Different CT densities of bamboo skewers were obtained when exposed to air, water and 2% Gastrografin in an in vitro experiment. Awareness of the possible variations in appearances of wooden foreign bodies in and around the bowel may aid their CT diagnoses.

Retained pieces of wood in the retromaxillary space: a case report

Detection and operative removal of wood as a foreign body in the cranio-maxillary area has received frequent attention in the literature. However, as a rule, most of the cases described are related to the orbit or the orbito-neurocranial space. Almost no literature exists on the detection and treatment of wooden foreign bodies in the retromaxillary space. The authors present an unusual case of long-term retained wood in this area in a child. The case inspires discussion of the general problem of detecting retained retromaxillary wood, even using modern diagnostic tools in this area and the question of the operative therapy, especially the most favourable surgical access.

Visibility of foreign bodies in soft tissue in plain radiographs, computed tomography, magnetic resonance imaging, and ultrasound. An in vitro study

We compared conventional plain radiography, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) with respect to their suitability for detecting foreign bodies in soft tissue in an in vitro model using a cow tongue to simulate orofacial soft tissues. Four samples of different sizes of fractured tooth crown, pieces of amalgam, glass, asphalt, composite, dry wood, and stone were each embedded under a 2-cm-thick flap on the caudal surface of the tongue. Plain radiographs revealed all the materials except wood, and there was some variation in the subjectively evaluated radiopacity of the materials which indicated the nature of the foreign bodies concerned. MRI proved to be the least suitable imaging method, as particles with a metallic content gave rise to powerful interference artifacts. CT and especially US proved to be suitable imaging methods for foreign-body detection in soft tissue. Amalgam produced a metallic streaking artifact in CT, which visualized wood as gas density, and depicted all the other materials as similar hyperdense masses. Ultrasound was both sensitive and specific in detecting foreign bodies in soft tissue. The particles were better defined in form and size with CT and US than with MRI or plain radiography. We conclude that when plain radiographs, history, and clinical examination fail to reveal the presence of superficial foreign bodies, US or CT can serve as an alternative method.