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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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Wen YH, Hou WJ, Lei WB, Chen FH, Zhu XL, Wang ZF, Ma RQ, Wen WP. Clinical Characteristics and Endoscopic Endonasal Removal of Foreign Bodies within Sinuses, Orbit, and Skull Base. Chin Med J (Engl) 2018; 130:1816-1823. [PMID: 28748855 PMCID: PMC5547834 DOI: 10.4103/0366-6999.211545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Foreign bodies within the sinuses, orbit, and skull base (FBSOS) are rare; hence, diagnosis and management guidelines are lacking. Endoscopic sinus surgery (ESS) removal is preferred because of the less invasiveness and minimal morbidity. This study was designed to summarize clinical experience with ESS management of FBSOS. Methods: We retrospectively reviewed clinical manifestations, imaging findings, treatment, and outcomes in consecutive patients with ESS removal of FBSOS between 2004 and 2015 at a tertiary academic medical center. The Chi-square test was performed to compare the infection rate between wooden and nonwooden FBSOS. Results: There were 23 male and five female patients, with median age of 11 years. FBSOS were located within the sinuses (86%), orbit (75%), and skull base/intracranial region (46%). Wooden FBSOS had a significantly higher risk of infection (78%) compared with nonwooden FBSOS (5%, P < 0.05). Contrast-enhanced computed tomography (CT) plus three-dimensional reconstruction was sensitive in all cases. Twenty-seven (96%) FBSOS were removed by ESS alone, while 1 (4%) FBSOS was removed using the combined ESS and lateral cervical approach. Four of the nine intracranial penetrating FBSOS patients had intraoperative cerebrospinal fluid (CSF) leak and received endoscopic CSF leak repair. Twelve (43%) patients suffered complications (meningitis, diplopia, and vision loss). Conclusions: ESS is a minimally invasive, safe, and promising surgical approach for FBSOS removal. Contrast-enhanced CT is effective in preoperative diagnosis and intraoperative guidance. Wooden FBSOS had higher risk of infection, thus antibiotics are recommended.
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Affiliation(s)
- Yi-Hui Wen
- Department of Otolaryngology, The First Affiliated Hospital, Otolaryngology Institute, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Wei-Jian Hou
- Department of Otolaryngology Head and Neck Surgery, Kiang Wu Hospital, Macau 999078, China
| | - Wen-Bin Lei
- Department of Otolaryngology, The First Affiliated Hospital, Otolaryngology Institute, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Feng-Hong Chen
- Department of Otolaryngology, The First Affiliated Hospital, Otolaryngology Institute, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Xiao-Lin Zhu
- Department of Otolaryngology, The First Affiliated Hospital, Otolaryngology Institute, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Zhang-Feng Wang
- Department of Otolaryngology, The First Affiliated Hospital, Otolaryngology Institute, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Ren-Qiang Ma
- Department of Otolaryngology, The First Affiliated Hospital, Otolaryngology Institute, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
| | - Wei-Ping Wen
- Department of Otolaryngology, The First Affiliated Hospital, Otolaryngology Institute, Sun Yat-sen University, Guangzhou, Guangdong 510080, China
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Management of Penetrating Skull Base Injury: A Single Institutional Experience and Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2838167. [PMID: 28828384 PMCID: PMC5554568 DOI: 10.1155/2017/2838167] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 06/18/2017] [Indexed: 01/14/2023]
Abstract
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.
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Bone beveling caused by blunt trauma: a case report. Int J Legal Med 2015; 130:771-5. [PMID: 26585737 DOI: 10.1007/s00414-015-1293-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 11/11/2015] [Indexed: 10/22/2022]
Abstract
The authors report a fatal case of blunt trauma to the skull caused by a rib of a beach umbrella. The skull displayed a round hole in the right temporal bone with typical internal beveling. Blunt trauma mimicking a gunshot wound (round perforation of the skull with internal beveling) is very rarely reported in the forensic literature.
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Temple N, Donald C, Skora A, Reed W. Neuroimaging in adult penetrating brain injury: a guide for radiographers. J Med Radiat Sci 2015; 62:122-31. [PMID: 26229677 PMCID: PMC4462984 DOI: 10.1002/jmrs.101] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/27/2015] [Accepted: 02/10/2015] [Indexed: 12/30/2022] Open
Abstract
Penetrating brain injuries (PBI) are a medical emergency, often resulting in complex damage and high mortality rates. Neuroimaging is essential to evaluate the location and extent of injuries, and to manage them accordingly. Currently, a myriad of imaging modalities are included in the diagnostic workup for adult PBI, including skull radiography, computed tomography (CT), magnetic resonance imaging (MRI) and angiography, with each modality providing their own particular benefits. This literature review explores the current modalities available for investigating PBI and aims to assist in decision making for the appropriate use of diagnostic imaging when presented with an adult PBI. Based on the current literature, the authors have developed an imaging pathway for adult penetrating brain injury that functions as both a learning tool and reference guide for radiographers and other health professionals. Currently, CT is recommended as the imaging modality of choice for the initial assessment of PBI patients, while MRI is important in the sub-acute setting where it aids prognosis prediction and rehabilitation planning, Additional follow-up imaging, such as angiography, should be dependent upon clinical findings.
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Affiliation(s)
- Nikki Temple
- Discipline of Medical Radiation Sciences, The University of Sydney Lidcombe, New South Wales, Australia
| | - Cortny Donald
- Discipline of Medical Radiation Sciences, The University of Sydney Lidcombe, New South Wales, Australia
| | - Amanda Skora
- Discipline of Medical Radiation Sciences, The University of Sydney Lidcombe, New South Wales, Australia
| | - Warren Reed
- Medical Image Optimisation and Perception Group, Discipline of Medical Radiation Sciences, The University of Sydney Lidcombe, New South Wales, Australia
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