Orbitocranial injury caused by wood

Spontaneous resolution of a wooden foreign-body granuloma in the conjunctiva of a child

A conjunctival foreign-body (FB) granuloma may result following trauma with synthetic and non-synthetic materials including organic and non-organic objects. Children usually manifest with FB granulomas that develop due to inoculation of FBs from soft toys, blankets or woollen clothes. Encapsu- lation of these FBs following a granulomatous inflammatory response results in a nodular swelling in the conjunctiva. Reports of a wooden FB granuloma in the conjunctiva in children are anecdotal. A 5-year-old boy suffered an un- witnessed direct ocular trauma to his left eye (OS) with a wooden arrow while playing. He developed redness and nodular swelling at the inferotemporal aspect of the OS without any visual complaints. The diagnosis of a wooden FB granuloma is a challenge to ophthalmologists and may go undetected in children who neglect their symptoms. It characteristically presents as a unilateral conjunctival nodule. Surgical excision is the definitive management. However, spontaneous extrusion of the FB might be observed due to protective blinking and tearing mechanisms in the eye.

Penetrating orbitocranial injury by shoji frame: A rare indoor accident in a Japanese style house

Background

To the best of our knowledge, there are no reports of penetrating orbitocranial injury (POCI) caused by a shoji frame.

Case Description

A 68-year-old man fell in his living room and was stuck headfirst by a shoji frame. At presentation, marked swelling was noted in the right upper eyelid, with the edge of the broken shoji frame exposed superficially. Computed tomography (CT) revealed a hypodense linear structure located in the upper lateral sector of the orbit, partially protruding into the middle cranial fossa. Contrast-enhanced CT revealed intact ophthalmic artery and superior ophthalmic vein. The patient was managed with frontotemporal craniotomy. The shoji frame was extracted by pushing out the extradurally located proximal edge from the cranial cavity and simultaneously pulling the distal edge from the stab wound in the upper eyelid. Postoperatively, the patient received intravenous antibiotic therapy for 18 days.

Conclusion

POCI can be caused by shoji frames as a result of an indoor accident. The broken shoji frame is evidently delineated on CT, which can result in prompt extraction.

[Penetrating head and brain injuries with nonmetal foreign bodies]

Penetrating brain injuries (PBI) are common in neurosurgical practice. Most of them are civil or war-time missile and blast injuries. This type of trauma is widely presented in neurosurgical publication, textbooks and clinical evidence-based guidelines. At the same time, PBI by non-metallic foreign bodies are very rare. All the data are limited to case reports and small series of cases. Moreover, there are no clinical consideration on diagnosis, treatment, complication, outcome and prognosis of PBI by non-metallic penetrating brain injuries. In this review all the data are summarized to provide recommendations on the diagnosis and treatment of PBI by non-metallic foreign bodies.

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.

Instantaneous death due to transorbital reverse penetration of a screw in an accidental fall: unusual autopsy case report and review of the literature

We present a peculiar autopsy case of a transorbital penetrating head injury, in a male worker, after an accidental fall onto a screw not completely stuck into a wooden board. A 13-cm screw entered the cranium 9.5 cm deep, penetrating with the flat end, a condition defined in literature as "reverse penetration." The death was instantaneous and caused by a neurogenic shock due to injuries to the brain stem and the right cerebellar hemisphere. These injuries, enabled by the length of the screw, are generally described in literature as due to nontransorbital penetrations, frequently associated with posterior entry and a large intracranial injury. The ocular globe has been, furthermore, perfectly preserved thanks to its mobility in the orbit. Even the dynamic of the incident is peculiar because of the stationary nature of the penetrating object, which the victim actively fell on by accident. To the best of our knowledge, the matter is therefore a very peculiar mortal case of transorbital intracranial penetration, whose verified injuries and dynamics are absolutely atypical. The case is now under discussion, and a review of pertinent literature is performed.

Corneal Ulcer Caused by a Wooden Foreign Body in the Upper Eyelid 6 Months after Minor Injury

PURPOSE

To describe a case of a wooden foreign body in the upper eyelid that remained asymptomatic for 6 months.

CASE REPORT

A 9-year-old boy was presented with moderate upper lid swelling. Medical history was positive for trauma with a wooden stick 6 months ago. At first, the condition resolved under local antibiotic treatment. Three weeks later, the inflammation recurred and a corneal ulcer developed. Examination under general anesthesia revealed a wooden foreign body which had remained in the upper eyelid since the first injury.

CONCLUSION

Organic foreign bodies in the eyelid can remain asymptomatic for a long period of time and can play a role in periocular inflammation. In case of doubt, children and other less cooperative patients should be examined under general anesthesia.

Patterns of transorbital intracranial injury: a review and comparison of occult and non-occult cases

The authors present an illustrative case of occult transorbital penetrating intracranial injury in a child, and review the literature concerning patterns of low-velocity, non-projectile injury during the era of modern CT and MRI study. Review of the mechanism of injury and analysis of surface entry site of penetration in 38 cases suggests recurring patterns of injury in occult and non-occult cases. A classification system based on surface entry zone site is applied to these injuries. Knowledge of the classification system should increase clinical suspicion for this type of often occult, penetrating orbito-cranial injury and direct appropriate investigation to provide earlier detection and diagnosis of the transorbital, intracranial penetration.

A mysterious temporal penetrating head wound without fracture

Unwitnessed head injuries are often diagnostic and management dilemmas. Low-velocity penetrating head wounds are rare. This paper describes a case of an accidental low-velocity penetrating head wound through the soft tissue of the temporal region. This lesion resulted in a deep intra-cerebral haemorrhage, after the initial assessment revealed no evidence of skull fracture, missile or missile track. The diagnostic evaluation and medical course of this case are presented. This is the first case in the medical literature of a brain injury by an object that penetrated the calvarium at low velocity but which did not produce a fracture of the skull. The evolving diagnostic dilemma is outlined to its conclusion, through 3 years of follow-up observation.

Usefulness of gradient-echo T2*-weighted MR imaging in evaluation of transorbital penetrating cerebral injury

Transorbital penetrating cerebral injury can cause severe morbidity if not identified and treated. After the removal of the object and without the clinical information, even the chance of suspicion of penetrating cerebral injury might be missed in the first investigation. We report a case of transorbital penetrating cerebral injury caused by a metal rod and diagnosed by MRI including gradient-echo T2*-weighted imaging.