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Hamamoto A, Michida T, Kawabata T, Fukumitsu R, Shinohara S. Multidisciplinary Approach for the Management of a Case With Craniofacial Penetrating Injury Compressing the Internal Carotid Artery. Cureus 2023; 15:e37340. [PMID: 37041854 PMCID: PMC10083102 DOI: 10.7759/cureus.37340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 04/13/2023] Open
Abstract
A craniofacial penetrating injury can be severe when a foreign object reaches the skull base, causing an intracranial hemorrhage or a pseudoaneurysm. We report a case of sharp craniofacial injury in which a thin wooden rod moved from the orbit to the internal carotid artery. With a multidisciplinary team consisting of neurosurgeons, plastic surgeons, and otolaryngologists, the foreign body was safely removed, and the patient healed without complications or sequelae. Careful risk management is necessary when treating a case of craniofacial penetrating injury because the depth of the foreign body cannot be determined from the external appearance, making it challenging to decide on the severity of the damage from the injury.
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Affiliation(s)
- Ayami Hamamoto
- Department of Otolaryngology - Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe, JPN
| | - Tetsuhiko Michida
- Department of Otolaryngology - Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe, JPN
| | - Tomoya Kawabata
- Department of Plastic Surgery, Kobe City Medical Center General Hospital, Kobe, JPN
| | - Ryu Fukumitsu
- Department of Neurological Surgery, Kobe City Medical Center General Hospital, Kobe, JPN
| | - Shogo Shinohara
- Department of Otolaryngology - Head and Neck Surgery, Kobe City Medical Center General Hospital, Kobe, JPN
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Calvaruso F, Alicandri-Ciufelli M, Presutti L, Molinari G. Technique for foreign-body removal with the use of transnasal endoscopic prelacrimal approach - A case report. Ann Maxillofac Surg 2022; 12:69-71. [PMID: 36199450 PMCID: PMC9527828 DOI: 10.4103/ams.ams_214_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 09/17/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022] Open
Abstract
The Rationale: Foreign body (FB) in the nasal cavities is a frequent cause of otolaryngology emergency consultation that sometimes requires surgical treatment. When there is involvement of the posterolateral wall of the maxillary sinus (MS) and of the pterygopalatine fossa (PPF), conventional techniques such as antrostomy and medial endoscopic maxillectomy may not allow sufficient domination of the surgical field. Patient Concerns: We report the case of a woman who suffered from intranasal trauma with epistaxis and pain. Diagnosis: A computed tomography scan revealed a metallic FB at the level of the right posterolateral wall of the MS, PPF, and greater wing of the sphenoid bone. Treatment and Outcome: A minimally invasive transnasal endoscopic prelacrimal approach was chosen for its removal. Take-away Lessons: The postoperative recovery was rapid and without complication.
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Lacuata JA, Tirona-Remulla A, Cabungcal AC, Santos RM. Combined external and endoscopic transnasal approach with use of a diamond burr in the removal of a fishing harpoon hook traversing bilateral sphenoid sinuses in a 22-year-old man. BMJ Case Rep 2021; 14:14/5/e239055. [PMID: 34016625 DOI: 10.1136/bcr-2020-239055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 22-year old construction worker was shot with a fishing harpoon gun on the left side of his face. He consulted at the emergency room 12 days postinjury, stable but with blurring of vision on the right. The shaft of the harpoon was protruding at the left preauricular area; the tip was neither visible nor palpable. Craniofacial CT scan and skull anteroposterolateral radiographs revealed the tip of the harpoon to be at the right orbital apex. A hook attached 1 cm from the tip was lodged in the sphenoid sinus. The hook was dismantled from the shaft via a combined external and endoscopic transnasal approach, enabling the shaft to be gently pulled. The hook, together with the tip, were removed endoscopically. The patient's visual acuity improved. He was discharged after 2 days on oral antibiotics with no deficits on follow-up.
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Affiliation(s)
- Jan Alexeis Lacuata
- Department of Otorhinolaryngology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Agnes Tirona-Remulla
- Department of Otorhinolaryngology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Arsenio Claro Cabungcal
- Department of Otorhinolaryngology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Romiena Mae Santos
- Department of Otorhinolaryngology, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
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Yoneoka Y, Aizawa N, Nonomura Y, Ogi M, Seki Y, Akiyama K. Traumatic Nonmissile Penetrating Transnasal Anterior Skull Base Fracture and Brain Injury with Cerebrospinal Fluid Leak: Intraoperative Leak Detection and an Effective Reconstruction Procedure for a Localized Skull Base Defect Especially After Coronavirus Disease 2019 Outbreak. World Neurosurg 2020; 140:166-172. [PMID: 32497852 PMCID: PMC7263210 DOI: 10.1016/j.wneu.2020.05.236] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/19/2022]
Abstract
Background Cerebrospinal fluid (CSF) leakage after penetrating skull base injury is relatively rare compared with close head injuries involving skull base fractures. Case Description We report the case of a 65-year-old man who had presented with epistaxis and serous rhinorrhea. When he had fallen to the ground near his bee boxes, a garden pole had poked into his right nostril. He had instantly removed the pole from his nostril himself. However, immediately after removal of the pole, he had developed nasal bleeding and serous rhinorrhea. He then drove to our emergency room. Computed tomography showed pneumocephalus with a minor cerebral contusion in the left frontal lobe and a penetrating injury in the left anterior skull base. His CSF leakage had not resolve spontaneously within 1 week after the injury with strict bed rest. We repaired the CSF leakage using a fat (adipose tissue)-on-fascia autograft plug and caulked the defect in the anterior skull base with the fat-on-fascia graft (FFG) plug through the left nostril with endoscopic guidance. The CSF rhinorrhea was successfully controlled. Intranasal local application of fluorescein aided in the detection of the direction of flow of the CSF leakage. Conclusions Endonasal endoscopic caulking of a skull base defect using an FFG plug can be useful to treat CSF leakage due to the localized skull base defect, especially in the coronavirus disease 2019 pandemic. It is simple, inexpensive, and timesaving. It requires no special skills nor sophisticated instruments that can cause aerosolization, reducing the risk of infection during the surgery.
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Affiliation(s)
- Yuichiro Yoneoka
- Department of Neuorsurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan.
| | - Naotaka Aizawa
- Department of Otorhinolaryngology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yoriko Nonomura
- Department of Otorhinolaryngology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Manabu Ogi
- Department of Otorhinolaryngology, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yasuhiro Seki
- Department of Neuorsurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Katsuhiko Akiyama
- Department of Neuorsurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
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Xu M, Luo Y, Chen P, Yi P, Wang CZ. Transnasal endoscopic treatment on a rare case of intracranial penetrating brain injury. Acta Neurol Belg 2020; 120:421-423. [PMID: 29855998 DOI: 10.1007/s13760-018-0955-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Accepted: 05/16/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Min Xu
- Department of Neurosurgery, Kunshan Hospital of Traditional Chinese Medicine, Kunshan Affiliated Hospital of Nanjing University of Chinese Medicine, Kunshan, 215300, Jiangsu, China
| | - Yu Luo
- Dalian Medical University, Dalian, 116027, Liaoning, China
| | - Pin Chen
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, China
| | - Pan Yi
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, China
| | - Cun-Zu Wang
- Department of Neurosurgery, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, China.
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Gray ML, Kappauf C, Govindaraj S. Management of an Unusual Intranasal Foreign Body Abutting the Cribriform Plate: A Case Report and Review of Literature. CLINICAL MEDICINE INSIGHTS. EAR, NOSE AND THROAT 2019; 12:1179550619858606. [PMID: 31308785 PMCID: PMC6604121 DOI: 10.1177/1179550619858606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 05/21/2019] [Indexed: 11/17/2022]
Abstract
A 35-year-old man with history of schizophrenia presented 3 weeks after placing a screw in his right nostril. Initial imaging showed a screw in the right ethmoid sinus with the tip penetrating the right cribriform plate. On exam, the patient was hemodynamically stable with purulent drainage in the right nasal cavity but no visible foreign body. While most nasal foreign bodies occur in children and are generally removed at the bedside, intranasal foreign bodies in adults tend to require further assessment. The foreign body in this case was concerning for skull base involvement and the patient was brought to the operating room (OR) with neurosurgery for endoscopic sinus surgery (ESS) and removal of foreign body. The screw was removed and the patient recovered with no signs of cerebrospinal fluid (CSF) leak postoperatively. Any concern for skull base or intracranial involvement should call for a full evaluation of the mechanism of injury and intervention in a controlled environment.
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Affiliation(s)
- Mingyang L Gray
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Catharine Kappauf
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Satish Govindaraj
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Transnasal Endoscopic Removal of a Knife Causing Penetrating Brain Injury in a Child. J Craniofac Surg 2018; 29:e694-e695. [PMID: 30157146 DOI: 10.1097/scs.0000000000004940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Transnasal penetrating brain injuries are rare and a medical emergency, which needs to be treated promptly. A 4-year-old male patient was brought to our emergency room with a knife sticking out of his nose. The patient was immediately taken to the operating room and the knife was removed under general anesthesia. No cerebrospinal fluid leakage or any bleeding was seen and so the operation was terminated. The authors herein report a penetrating brain trauma through to the cella turcica with a knife that improved without any sequelae at a child.
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Li Z, Chen J, Qu X, Duan L, Huang C, Zhang D, Hou L. Management of a Steel Bar Injury Penetrating the Head and Neck: A Case Report and Review of the Literature. World Neurosurg 2018; 123:168-173. [PMID: 30447445 DOI: 10.1016/j.wneu.2018.11.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 11/02/2018] [Accepted: 11/04/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Nonmissile penetrating injuries to the head and neck caused by a steel bar are rare, and a standard management strategy is lacking. CASE DESCRIPTION A 42-year-old woman sustained a steel bar injury with penetration of the head and neck. Computed tomography and three-dimensional reconstruction were performed for preoperative evaluation. Digital subtraction angiography was performed to confirm potential vascular injury. The steel bar was successfully removed through an open surgical procedure by a multidisciplinary team. CONCLUSIONS Relevant literature regarding nonmissile penetrating injuries involving a steel bar was reviewed to propose appropriate management strategies. Comprehensive imaging evaluation and prompt surgery by a multidisciplinary team contributed to the successful removal of the steel bar.
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Affiliation(s)
- Zhenxing Li
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jigang Chen
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiaolin Qu
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Liwei Duan
- Department of Emergency, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chenguang Huang
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Danfeng Zhang
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Lijun Hou
- Department of Neurosurgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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Kato H, Kanno S, Ohtaki J, Nakamura Y, Horita T, Fukuta M, Eguchi K, Hassan Gaballa M, Aoki Y. A case of transnasal intracranial penetrating injury with skull base fracture caused by a broken golf club shaft. Leg Med (Tokyo) 2018; 32:57-60. [PMID: 29549791 DOI: 10.1016/j.legalmed.2018.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/06/2018] [Accepted: 03/11/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Hideaki Kato
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Sanae Kanno
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Jun Ohtaki
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yoshimi Nakamura
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Tetsuya Horita
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mamiko Fukuta
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kazuhito Eguchi
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Mohamed Hassan Gaballa
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasuhiro Aoki
- Department of Forensic Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Ghadersohi S, Ference EH, Detwiller K, Kern RC. Presentation, workup, and management of penetrating transorbital and transnasal injuries: A case report and systematic review. Am J Rhinol Allergy 2018; 31:29-34. [PMID: 28452700 DOI: 10.2500/ajra.2017.31.4421] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A foreign body (FB) penetrating intracranially after passing transorbitally or transnasally is a rare occurrence. However, otolaryngologists are increasingly being asked to participate in the care of these patients for both endoscopic removal of the object and repair of any skull base defects. OBJECTIVE To assess the presentation, workup, and management of transnasal or transorbital penetrating FB injury. METHODS Systematic review of the presentation, workup, and management of transnasal or transorbital penetrating FB injury; plus, a case report of a 53-year-old woman with a transorbital penetrating rose bush branch. We searched medical literature data bases, which resulted in 215 total titles, which were then narrowed based on inclusion and exclusion criteria. RESULTS Thirty-five cases of transorbital or transnasal low-velocity trauma that involved the paranasal sinuses were reviewed from 33 articles. The average age was 30 years, 40% of the objects were made of wood. Fifty-seven percent of the cases were transorbital, whereas 43% were transnasal. Forty-six percent of the surgical interventions were completed endoscopically or with endoscopic assistance. Complications of injury were common, with 66% of patients experiencing cerebrospinal fluid leaks; 23%, permanent blindness; 17%, meningitis; 14%, ophthalmoplegia; 9%, decreased visual acuity; and 3%, brain abscess. Our patient presented with a traumatic cerebrospinal fluid leak, and recovered well after transorbital and endoscopic removal of the branch, skull base repair, and a prolonged course of antibiotics and antifungal medications. CONCLUSIONS Transnasal and transorbital penetrating FB injuries are a relatively uncommon occurrence but when they do occur require rapid workup and interdisciplinary management to prevent acute and delayed complications.
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Affiliation(s)
- Saied Ghadersohi
- Department of Otolaryngology-Head and Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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11
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Bidirectional Management of a Transnasal Intracranial Chopstick Transecting Optic Nerve. J Craniofac Surg 2018; 29:e398-e402. [PMID: 29481516 DOI: 10.1097/scs.0000000000004405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Herein, the authors report a rare patient with a transnasal intracranial penetration injury caused by a chopstick that resulted in optic nerve transection as well as the removal of the chopstick using a bidirectional approach. A 25-year-old male presented to our emergency department with right blindness and bilateral epistaxis. Preoperative computed tomographic angiography demonstrated a transnasal stick-like foreign body causing a skull base fracture and suspected vascular injury. Due to the shape of the chopstick and the high risk of massive bleeding, an exclusively endoscopic or open craniotomy approach is not suitable for removal. A bidirectional method, including both an open craniotomy and transnasal endoscopy, was used to remove the chopstick. After the operation, there were no further neurologic deficits or complications during the treatment course and follow-up. The bidirectional approach may provide an alternative method to address a foreign body when the patient is not a candidate for an exclusively endoscopic or open craniotomy approach management.
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12
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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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Li XS, Yan J, Liu C, Luo Y, Liao XS, Yu L, Xiao SW. Nonmissile Penetrating Head Injuries: Surgical Management and Review of the Literature. World Neurosurg 2016; 98:873.e9-873.e25. [PMID: 27931948 DOI: 10.1016/j.wneu.2016.11.125] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/24/2016] [Accepted: 11/25/2016] [Indexed: 01/12/2023]
Abstract
BACKGROUND Nonmissile penetrating head injuries (NPHIs) in the civilian population are rare but potentially fatal. Although numerous cases have been reported in the literature, the surgical management of such injuries is still ambiguous, especially with development of surgical techniques. Here, we report 5 cases of NPHIs managed with different surgical techniques and review the literature on surgical treatment of these injuries to outline the appropriate management for these patients from a neurosurgical perspective. METHODS We retrospectively reviewed 5 cases of NPHIs managed surgically in our department. The clinical data were collected, including cause, type of objects, way of penetration, initial clinical evaluation, imaging, surgical intervention, postoperative care, complication, follow-up, and outcome. In addition, a systematic review of the literature was performed in the PubMed database to search for articles on surgical treatment of these injuries. RESULTS These 5 cases were caused by twisted steel bar, electric welding rod, and sewing needle, respectively. Preoperative imaging, including computed tomography, magnetic resonance imaging, and digital subtraction angiography, was selectively performed to assist the operative plan. Foreign objects were removed surgically in all cases. Postoperative prophylactic administration of antibiotics and anticonvulsants was used to prevent infectious and epileptic complications. Most of the patients achieved a better outcome except for one. CONCLUSIONS NPHIs can be fatal but they can be managed with satisfactory results by proper preoperative imaging evaluation, rapid appropriate surgical management, and accurate postoperative care. Personalized surgical intervention should be undertaken depending on the mechanism and extent of the NPHI.
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Affiliation(s)
- Xi-Sheng Li
- Department of Neurosurgery, The First Affiliated hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jun Yan
- Department of Neurosurgery, The First Affiliated hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Chang Liu
- Department of Neurosurgery, The First Affiliated hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Yu Luo
- Department of Neurosurgery, The First Affiliated hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xing-Sheng Liao
- Department of Neurosurgery, The First Affiliated hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Liang Yu
- Department of Neurosurgery, The First Affiliated hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Shao-Wen Xiao
- Department of Neurosurgery, The First Affiliated hospital of Guangxi Medical University, Nanning, Guangxi, China.
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Nguyen HS, Oni-Orisan A, Doan N, Mueller W. Transnasal Penetration of a Ballpoint Pen: Case Report and Review of Literature. World Neurosurg 2016; 96:611.e1-611.e10. [PMID: 27641266 DOI: 10.1016/j.wneu.2016.09.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 09/03/2016] [Accepted: 09/06/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transnasal penetration by a nonmissile foreign body is a rare injury. Consequently, appropriate management remains controversial. We report a case of transnasal penetration by a ballpoint pen and review the literature. To our knowledge, this is the first living patient who sustained carotid artery damage from a transnasal penetrating intracranial injury. CASE DESCRIPTION A 56-year-old female presented with a ballpoint pen lodged through her left nostril. She exhibited right cranial nerve palsies (III, IV, VI, and V1). A computed tomography (CT) scan of the head revealed a foreign body in the left nasal cavity traversing the ethmoid/sphenoid and likely through the right superior orbital fissure and cavernous sinus, with the distal tip adjacent to the right atrium. CT angiography revealed nonopacification of the right internal carotid artery (ICA) from the mid-petrous segment to the ophthalmic segment. Subsequently, she underwent coil embolization of the proximal right ICA, followed by a right frontotemporal craniotomy with anterior temporal lobectomy to skeletonize the pen and right distal ICA, and finally clipping of the ICA distal to the pen and prompt transnasal endoscopic removal of the pen. There were no hemorrhagic complications. She awoke at her neurologic preoperative baseline. CONCLUSION Injuries such as the one described here should be managed through a multidisciplinary approach. The trajectory of the foreign body should be delineated through CT imaging, along with vascular imaging if appropriate. If there are signs of vascular injury, then attempts to maintain proximal and distal control are prudent to avoid hemorrhagic complications. This combined endovascular-endoscopic-open craniotomy approach has not been reported previously in the literature.
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Affiliation(s)
- Ha Son Nguyen
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
| | - Akinwunmi Oni-Orisan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Ninh Doan
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Wade Mueller
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Zyck S, Toshkezi G, Krishnamurthy S, Carter DA, Siddiqui A, Hazama A, Jayarao M, Chin L. Treatment of Penetrating Nonmissile Traumatic Brain Injury. Case Series and Review of the Literature. World Neurosurg 2016; 91:297-307. [DOI: 10.1016/j.wneu.2016.04.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 10/22/2022]
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16
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Gopaul R, Xiao WS, Yan J, Wei DZ. Intracranial foreign body through the sagittal sinus: case report and review of literature. Chin Neurosurg J 2016. [DOI: 10.1186/s41016-016-0029-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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17
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Penetrant injury of the nose with a foreign material. J Craniofac Surg 2014; 24:1853-6. [PMID: 24036798 DOI: 10.1097/scs.0b013e318293f900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Nazar R, Cabrera N, Martelo G, Machiavello C, Naser A. Unusual Sinonasal Foreign Body: Presentation of Three Cases. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014. [DOI: 10.1016/j.otoeng.2013.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Nazar R, Cabrera N, Martelo G, Machiavello C, Naser A. Unusual sinonasal foreign body: presentation of three cases. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2014; 65:109-13. [PMID: 24495948 DOI: 10.1016/j.otorri.2013.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 11/18/2013] [Accepted: 11/28/2013] [Indexed: 10/25/2022]
Abstract
Sinonasal foreign bodies are rare clinical entities. Their presence in the sinuses can originate complications, so their removal is always indicated. We present 3 cases of sinonasal foreign body, indicating their symptoms, imaging findings and surgical removal. Each patient was assessed with computerized tomography of the sinuses, rigid endoscopy, and then surgical removal. We confirmed the presence of the foreign bodies in all 3 cases and then performed a successful surgical removal by transnasal endoscopy. Sinonasal foreign bodies are infrequent entities that require surgical removal to prevent complications, with transnasal endoscopic surgery being the most commonly used surgical approach.
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Affiliation(s)
- Rodolfo Nazar
- Servicio de Otorrinolaringología, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Natalia Cabrera
- Servicio de Otorrinolaringología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Grettel Martelo
- Servicio de Otorrinolaringología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Cecilia Machiavello
- Servicio de Otorrinolaringología, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Alfredo Naser
- Servicio de Otorrinolaringología, Hospital Clínico Universidad de Chile, Santiago, Chile
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