Penetrating Craniofacial Injuries in Children with Wooden and Metal Chopsticks

Abstract

Penetrating craniofacial injuries with chopsticks in children are peculiar accidents in the Oriental culture. All 10 cases previously reported were caused by wooden chopsticks that required surgical operations. However, there are no reported injuries with metal chopsticks in the past literature which should have been as common as that of wooden chopstick injuries in Asia. We evaluated the difference of injury patterns and clinical observations between wooden and metal chopstick injuries. We reviewed 6 treated children with penetrating craniofacial injuries from chopsticks: one wooden and five metal chopsticks. One child who had penetration through the nasal cavity presented with temporary rhinorrhea, another with mild hemiparesis, and one child with temporary upward gaze limitation of the left eye. Radiological examination revealed 1 patient with epidural hemorrhage, 1 patient with minimal subdural hemorrhage, and 4 with intracerebral hemorrhage that were fortunately too small to receive surgery. We performed surgical procedure only for a child who had a wooden chopstick that had impacted into the temporal cortex. We followed up all 6 children for more than 1 year, and found that all had fully recovered to near-normal neurological status. We observed that penetrating craniofacial injuries with metal chopsticks rarely require surgical intervention and usually results in good outcome because the resultant wound is usually small without broken fragments compared to injuries with wooden chopsticks.

A case of a wooden foreign body penetrating the oral cavity and reaching the posterior neck

“…The number of cases involving chopsticks is low, at six, [2][3][4][5]7,8 all of which occurred in children in Japan and South Korea, suggesting a close relationship with the use of chopsticks in the local culture. These six cases involved lodgment in the cranial base, intracranial locations, temporal region of the head, or nose.…”

“…Chopsticks are generally of plant origin, and although localisation is usually attempted by ultrasonography, CT, and MRI, wooden foreign objects cannot always be identified. 3,5,6,9 In ultrasonography, a foreign body of plant origin presents a high-echo pattern, hampering precise localisation when located in a region surrounded by bony tissues. 1 In CT, these are visualised as a nonattenuated area due to the high air content.…”

A successfully-treated case of penetrating facial trauma

“…Patients should be given tetanus shots and preoperative and postoperative antibiotics, if indicated. Some reports suggest that although penetrating craniofacial injuries with a wooden bar, which can affect extensively by broken fragments, usually require surgical intervention, injuries with a metal bar can be managed without surgical intervention with good outcomes [8].…”

Interdisciplinary endoscopic assisted surgery of a patient with a complete transorbital intracranial impalement through the dominant hemisphere

“…Sharp or blunt transorbital impalement injuries are rarely described in children and occur most of the time during playing, as in this case. [2,[4][5][6]8] Due to the thin anatomy of the orbita, where the bone is of least resistance, high-velocity injuries may lead to a continuation of the impalement intracranially.…”