Seeing Through The Problem: The Use Of 3-D CT Reconstruction In The Removal Of Multiple Foreign Bodies

Abstract

We report an unusual but invaluable use of three dimensional computed tomography (CT) reconstruction for the removal of multiple foreign bodies in a 7 year old boy following trauma. In a road traffic accident (RTA) a 7 year old boy sustained multiple facial lacerations from shattered glass.Facial CT scans were performed to exclude a mandible fracture requiring intervention, following which it was possible provide three dimensional reconstructions of the boy's face revealing thirteen pieces of glass. Using this reconstruction as a guide in theatre twelve of the thirteen pieces of glass were retrieved with a satisfactory cosmetic result. Case reportWe report a 7-year-old boy who presented following an RTA in which he was a restrained rear seat passenger. He was noted to be agitated at the scene and required to be sedated prior to transfer to the accident and emergency department. On arrival his airway, breathing and circulation were stable.His GCS was 10 with eyes opening to pain, vocalising inappropriately and localising to pain. He was noted to have multiple lacerations on the left side of his face, with fragments of glass visible in the lacerations, along with significant swelling of the left cheek and mandibular area. He was intubated and ventilated for a CT head scan. This scan excluded an intracranial bleed and he was transferred to the Children's Hospital ventilated with spinal immobilisation in situ.As he was ventilated it was not possible to clear his cervical spine and likewise it was not possible to achieve the standard plain radiographs to visualise his mandible. He underwent a facial CT scan which revealed bilateral mandibular condyle fractures, which did not require intervention. (Figure 1)