Penetrating transorbital injury by a coloring pencil in a 3-year-old child: A case report

Abstract

A transorbital penetrating injury by a foreign body is an extremely rare type of injury, and its severity is often difficult to estimate by examination of the superficial wound alone. Thus, such injuries are challenging for neurosurgeons to investigate and manage. We herein present a peculiar case involving a 3-year-old girl with a penetrating transorbital skull-base injury caused by a coloring pencil and discuss the anatomical location of the foreign body, radiological examination findings, diagnosis, and treatment strategy. The pencil was completely removed by manual extraction. Follow-up investigations confirmed a good outcome. Multidisciplinary cooperation, radiological examination, correct diagnosis, timely treatment, and detailed follow-up studies are necessary to manage penetrating transorbital skull-base injuries caused by foreign bodies. The orbital walls are very thin in children, and the orbital roof and superior orbital fissure are often penetrated by foreign bodies in cases such as that described herein. The anatomical location of the foreign body influences the clinical management strategy.

Rubber Bullet Induced Traumatic Brain Injury

“…This property of the orbit confers a unique vulnerability to penetrative cerebral injury when compared to other facial structures. [24][25][26][27][28][29][30][31][32][33][34][35] The case presented here challenges the implied notion that only penetrative injuries by rubber bullets can cause serious harm. Indeed, the patient from this case experienced complete shattering of the NOE complex extending up to the anterior skull base, causing a TBI and CSF leak.…”

“…For example, much of the literature regarding TBI due to a variety of causes centers on the relative thinness of the bony structures of the orbit. This property of the orbit confers a unique vulnerability to penetrative cerebral injury when compared to other facial structures 24–35 . The case presented here challenges the implied notion that only penetrative injuries by rubber bullets can cause serious harm.…”

Incidence of Pencil and Pen Eye Injury among Children in Anambra State, South-East, Nigeria: Ten Year Retrospective Study

“…Fifty six point five percent (13) of the eye injuries were caused by pencil while 43.5% (10) were caused by pen; pencil: pen = 1.3:1 (P = 0.000). Seventy-seven percent of the pencil injuries occurred in children five years and below.…”

“…Majority of injuries from pencil and pen in children occur accidentally while writing, drawing, painting or playing with these writing materials either as a stab/poke injury or missile injury [8,10,12]. The child may also trip and fall on a pencil held in the hand [13,14]. The injury could be inflicted by a fellow child or could by self-inflicted [5,8,9].…”

“…However, with minimal tissue damage and prompt adequate management, good visual acuity could be achieved even when the presenting acuity is poor [8]. Orbital penetration could also occur following pencil/pen injury [9,13]. A survey of 36 children with self-inflicted pencil eye injury showed that the right eye is as twice involved as the left eye, possibly because most people are right handed [5].…”