Trauma is one of the leading causes of death worldwide. Due to its anatomy and position in the facial skeleton, the orbit becomes a region susceptible to trauma which may also involve the penetration of foreign bodies (FBs). These events can have serious repercussions depending on their extent due to the proximity of the orbit with other noble structures of the face and skull. Because of this, a system of prehospital management of traumas must be established, in order to promote a better prognosis for patients. The present study aims to report the case of a patient suffering from a motorcycle accident with multiple fragments of FBs in the region of orbit-zygomatic-maxillary complex. The emergency surgical removal of the fragments was performed by a multidisciplinary team, involving Ophthalmology and Oral and Maxillofacial Surgery and Traumatology (OMST). Wound cleansing and debridement were performed with subsequent removal of the foreign bodies by the OMST team, in addition to the reduction and fixation of related fractures. As for Ophthalmology, the evisceration of the affected eye was performed due to its anatomical and functional impairment. The patient is 12 months postoperatively, with no aesthetic or functional complaints regarding OMST. The anatomical knowledge of the traumatized region, besides the establishment of the conduct regarding the removal of possible associated foreign bodies are required so that the success of the treatment can be obtained, aiming to minimize the damages to the patient.

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There should be no contrast enhancement. If the diffusion is essential to make the distinction between masses and other lesions for the differential diagnosis. Since the main feature imaging is requested, their signal is high in DWI and ADC images because of the increasing diffusion of molecules. PAC covers the internal carotid artery but it doesn't compress it. Most importantly, it is necessary to see typical suppression of CSF in FLAIR sequences. 6 These radiological features are present in our case.Arachnoid cyst is the main lesion in the differential diagnosis. However, some radiological features easily distinguish it from PAC. Massive erosion or indentation of a petrous apex is not expected. The other diseases in the differential diagnosis of the PAC include benign obstructive lesions of air cells (cholesterol granuloma and mucocele), congenital or acquired cholesteatoma, epidermoid cyst, and apical petrocyte. 4,7 Let's look at the radiological features that may be useful in the differential diagnosis: a signal intensity similar to that of CSF is observed in the case of effusion of petrous air cells, which is a favor in PAC. However, the nondeterioration of the air cells' trabecular structure and the absence of expansion are directing to other differential diagnoses. Cholesterol granuloma has a high signal in T1 WI unlike PAC. The signal of mucocele is similar to PAC in conventional MRI sequences, but signal differences are occurring in FLAIR sequences and DWI. Contrast enhancement is not usually seen in PAC. If contrast enhancement is present, only a very thin rim enhancement is observed. Indeed, there is no contrast enhancement in our case.According to the literature, PAC is accompanied by empty sella in 5% to 35% of the cases. The formation mechanism of the empty sella is similar to PAC's one. Increased intracranial pressure causes enlargement of sella turcica and indentation of the suprasellar cistern to this area. Due to the reasons explained above, since the mechanism is different in unilateral cases, empty sella is expected to occur only in patients with bilateral PAC. However, no study classifies empty sella according to unilateral and bilateral patients. In addition, there are reports about the relationship between PAC and Usher syndrome (a genetic syndrome associated with deafness/hearing loss and retinitis pigmentosa) in the literature. 8 In our patient, sella turcica was broad but there was no evidence of empty sella. Considering the benign clinic of our case, it was thought that the etiologic condition causing PAC probably could not create sufficient pressure for empty sella formation but widened the sella.In our case, a severe headache was the dominant symptom. 9 Usually, no treatment is required for asymptomatic cases. However, in symptomatic ones, there is a complicated treatment process including surgery. 10 CONCLUSIONS Petrous apex cephalocele is a rare type of cephalocele. Our case is one of the first 50 reported cases. Bilateral cases are rarer. They are a different entity from unilater...