Penetration Injury Caused by a Wooden Chopstick That Led to Masticator Space Infection: A Case Report

Abstract

Penetrating injuries of the face are commonly observed in the emergency room (ER). It is difficult to identify foreign substances in the face when the wound opening is small with insufficient operative field exposure. Furthermore, wood is not easily detected on computed tomography (CT), performed as the first assessment for facial trauma. A 47-year-old woman visited the ER with a 0.5-cm open wound in the left temporal area. She stated that the wound was caused by a wooden chopstick, which had already been removed. No other specific findings were observed on frontal plane skull radiographs; the patient was discharged after primary closure. Approximately 14 days later, she revisited the ER complaining of extensive swelling and erythema in the left cheek. Enhanced facial CT revealed an extensive abscess in the left masticator space. Incision and drainage were performed in the extraoral and intraoral regions; however, no improvement was observed. Follow-up ultrasonography revealed a foreign body in the left cheek. Under general anesthesia, exploration was performed under the temporalis plane; several wooden chopstick pieces amounting to a total length of almost 11 cm were found and removed. It is important to identify foreign bodies in wounds caused by wooden chopsticks using various imaging studies.

Residual foreign body inflammation caused by a lumber beam penetrating the facial region: a case report

“…Simple radiography may not be of much help for this purpose due to the radiolucent nature of wood. Ultrasonography can be used to detect foreign bodies hidden in soft tissue, but its accuracy may be affected by the skill of the practitioner, the depth at which the foreign body is located, and edema of the tissue around the foreign body [2,3,5,7]. On a CT scan, wood can be seen with low attenuation, similar to air, due to its porosity in the early stages of trauma.…”

“…Penetrating wounds to the face are cosmetically devastating and life-threatening injuries that often necessitate emergent management [1,2]. X-ray, ultrasonography, and computed tomography (CT) can be used to identify remaining foreign bodies requiring removal, but some foreign bodies may be difficult to detect depending on their type or size [2,3].…”