Presentation, Workup, and Management of Penetrating Transorbital and Transnasal Injuries: A Case Report and Systematic Review

Ghadersohi, Saied; Ference, Elisabeth H.; Detwiller, Kara Y.; Kern, Robert C.

doi:10.2500/ajra.2017.31.4421

Cited by 13 publications

(11 citation statements)

References 31 publications

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“…Case reports describe a higher incidence among children and the elderly, some cases resulting in death [1, 2]. General recommendations advise that patients suffering from these kinds of injuries are treated at a facility with a highly specialized trauma team with access to relevant imaging and surgical expertise [3-5].…”

Section: Discussionmentioning

confidence: 99%

Penetrating Orbital Sphenoid Sinus Trauma with a Wooden Stick: A Challenging Case Report

Hansen

Thorsberger

Jørgensen

et al. 2020

Case Rep Ophthalmol

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Transorbital and intra-sphenoidal traumas are relatively uncommon, can be challenging to manage, and are associated with a high risk of complications and potentially fatal outcome. Transorbital and intra-sphenoidal trauma pose a medical challenge due to close relationship to delicate and critical anatomical structures, such as the globe, optic nerve, the ophthalmic internal carotid arteries, and central nervous system. Rapid admission to a level 1 trauma center with a high surgical expertise level is essential to ensure the best possible treatment and outcome. We present a case of a 75-year-old man who had a severe orbital trauma, where a wooden foreign object penetrated the orbit into the sphenoid sinus without penetrating its posterior wall. This case is important because of the rare trauma presentation with a wooden foreign object, which can easily be missed on computed tomography. The case also illustrates the importance of close collaboration between ophthalmologists and rhinologists when challenged with severe orbital sphenoid sinus trauma.

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Section: Discussionmentioning

confidence: 99%

Penetrating Orbital Sphenoid Sinus Trauma with a Wooden Stick: A Challenging Case Report

Hansen

Thorsberger

Jørgensen

et al. 2020

Case Rep Ophthalmol

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“…In conclusion, the recent trend is toward a less aggressive strategy for management of penetrating craniofacial injury, 7 particularly for patients whose injury site is located away from vital intracranial arteries and eloquent areas. For patients with intracranial artery damage, simple withdrawal of a foreign body that has penetrated the cranium may be disastrous because of catastrophic arterial bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…Multidisciplinary approaches to the presurgical evaluation and radiological examination in patients with penetrating transorbital injuries are mandatory and should include neurological and ophthalmological examinations. 7 , 9 – 11 For example, the Kerning or Babinski signs are negative, the bilateral pupils are isocoric and normally responsive to light, the eyeball is intact, and visual acuity and ocular movements are normal. The outcome of intraorbital penetrating injuries varies significantly depending on the type of injury and the involvement of vital structures.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Transorbital impalement by a pencil is unusual and should be promptly managed because of its association with high infection and mortality rates. 7,8 We herein report a case involving a 3-year-old girl with a penetrating craniofacial injury and discuss the mechanism of injury, imaging evaluation findings, surgical intervention, postoperative monitoring, and surgical features of this unusual case.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2019

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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.

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“…Ghadersohi et al 13 performed a systematic review of penetrating skull base injuries from the surgical rhinology perspective. In this review, fewer than half of the cases were managed under endoscopic visualization or with endoscopic assistance.…”

Section: Skull Basementioning

confidence: 99%

21st Century Rhinology

2017

Am J Rhinol�Allergy

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21st century rhinology T wenty-first century rhinology encompasses both medical and surgical treatments of a wide range of diseases and conditions of the nose, paranasal sinuses, and adjacent structures. Now under the leadership of coeditors Rakesh Chandra, M.D., and Raj Sindwani, M.D., as well as Deputy Editor of Allergy Anju Peters, M.D., the American Journal of Rhinology and Allergy, as a leading otorhinolaryngology journal, captures the breath of the field in articles submitted by authors from across the entire world. BASIC SCIENCEAlthough a role for the use of doxycycline has emerged in the treatment of chronic rhinosinusitis, the mechanisms for the antibiotic's anti-inflammatory effects are poorly understood. Shin et al. 1 examined the effect of doxycycline in an in vitro model of A549 and nasal epithelial cells. They showed that doxycycline inhibited TGF ␤1-induced migration as well as the epithelial to mesenchymal transition.Cigarette smoke adversely impacts sinonasal mucosal function (consistent with its adverse health impacts throughout the body) through various mechanisms. Shin et al. 2 used an in vitro model to examine the impact of cigarette smoke extract (CSE) on nasal fibroblasts. They demonstrated that CSE stimulates VEGF expression through its apparent downregulation of TLR4 transcription. Interesting, pretreatment with reactive oxygen species reduced CSE-initiated VEGF expression. The T2R38 bitter taste receptor has a role in innate immunity mechanisms through nitric oxide production. Yan et al., 3 built on this work and established that both T2R4 and T2R16, two additional bitter taste receptors, were expressed in cilia of human epithelial cells and triggered nitric oxide production.

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Presentation, Workup, and Management of Penetrating Transorbital and Transnasal Injuries: A Case Report and Systematic Review

Abstract: Transnasal and transorbital penetrating FB injuries are a relatively uncommon occurrence but when they do occur require rapid workup and interdisciplinary management to prevent acute and delayed complications.

Cited by 13 publications

References 31 publications

Penetrating Orbital Sphenoid Sinus Trauma with a Wooden Stick: A Challenging Case Report

Penetrating Orbital Sphenoid Sinus Trauma with a Wooden Stick: A Challenging Case Report

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

21st Century Rhinology

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