Penetrating Midface Trauma: A Case Report, Review of the Literature, and a Diagnostic and Management Protocol

Orbital Penetrating Injuries: A Review on Evaluation and Management

“…The eye makes up less than 1% of total body surface area, and yet the eye is injured in almost 10% of nonfatal injuries and one-third of injuries involving the midface. 3,4 In general, penetrating head injuries are rare, making up 0.4% of all head injuries. However, a notable proportion of penetrating head injuries are transorbital: 24% of adult and 45% of pediatric penetrating head injuries are transorbital.…”

“…The literature suggests that these injuries are more common in young males. 4,9 High-velocity missile injuries that occur in civilian life are often homicidal or suicidal attempts. 10 A systematic review of 57 nonmissile midface injuries (one-third of which involved the orbit) demonstrated that the etiologies of trauma to the midface were accidental trauma (54%) and assault (46%), with knives being the most common weapon (30%).…”

“…10 A systematic review of 57 nonmissile midface injuries (one-third of which involved the orbit) demonstrated that the etiologies of trauma to the midface were accidental trauma (54%) and assault (46%), with knives being the most common weapon (30%). 4 A quarter of these injuries involved deeper structures, such as the skull base, carotid siphons, or sphenoid sinuses, and a quarter involved the brain or brain stem. A review of 37 nonmissile orbitocranial injuries found the majority of cases were accidental (either falling onto a small-diameter sharp object or while carrying an object in hand), or from assault (being struck by a small-diameter object in an altercation); a minority were self-inflicted in a suicide attempt or other self-injury.…”

“…If 2 orthogonal planes are obtained and the penetrating object is radiopaque, some inferences can be made regarding the involved structures. 4 However, a review of 37 orbitocranial injuries found that plain skull radiographs were often inadequate when used as first-line imaging. The study showed that plain skull radiographs missed 75% of retained foreign bodies, 67% of fractures, and 100% of abscesses.…”

Endoscopic Removal of a Nasopharyngeal Foreign Body Stuck Within the Sphenoid Bone Using the Endonasal Transseptal Approach

“…2-4 Additionally, many vital structures, including the skull base, cranial nerves, and internal carotid artery surround the nasopharynx; therefore, injuries to these structures may cause serious and life-threatening complications. 5 Accurate grasp of the FB location and careful removal are essential. Here, we report a case of a patient with nasopharyngeal FB removed using an endoscopic endonasal transseptal approach after evaluation with three-dimensional volume rendering (3D-VR) images.…”