Temporal Approach to Removal of a Large Orbital Foreign Body

Abstract

High-velocity injuries, such as those that stemming from a gunshot or industrial accident, can lead to the occurrence of an intraorbital foreign body, 1 often accompanied by penetrating ocular trauma. 2 In such cases, the ophthalmic examination should begin with the documentation of visual acuity, followed by a detailed examination of the orbit for periorbital and subconjunctival hemorrhage and proptosis. Extraocular movements and visual fields should be examined and a careful inspection of the globe should be performed to determine the presence or absence of perforation. 3 With advances in radiological techniques, such as high-resolution reconstruction computed tomography, the assessment of such injuries has become easier and more accurate. 4 The retrieval of an intraorbital foreign body can be difficult because of the proximity of critical structures, such as the contents of the superior orbital fissure, the optic nerve, ethmoidal vessels, and cranial structures. 5 Among the different approaches employed in the treatment of facial injuries, the coronal approach, which was popularized by Tessier, is one of the most versatile for midface surgeries. 6 However, the large incision causes concern regarding the visible postoperative scar. Thus, several techniques have been described to minimize scar visibility, including a straight incision, coronal incisions, a gull-wing or W-shaped incision, and the use of six short linear incisions. 7 This article describes the use of the temporal approach on a firearm victim in whom the breech of a rifle had impaled orbital region, with the extremity lodged in the infratemporal fossa. Case ReportA 31-year-old male patient presented to the Regional Trauma Hospital in Campina Grande (state of Paraíba, Brazil) following an accident with the breech of a rifle, which had Keywords ► intraorbital foreign body ► orbit ► temporal AbstractAccidents with firearms can result in extensive orbital trauma. Moreover, gun parts can come loose and impale the maxillofacial region. These injuries can cause the loss of visual acuity and impair eye movements. Multidisciplinary treatment is required for injuries associated with this type of trauma. Computed tomography with threedimensional reconstruction is useful for determining the precise location and size of the object lodged in the facial skeleton, thereby facilitating the planning of the correct surgical approach. The temporal approach is a fast, simple technique with few complications that is indicated for access to the infratemporal fossa. This article describes the use of the temporal approach on a firearm victim in whom the breech of a rifle had impaled orbital region, with the extremity lodged in the infratemporal fossa.

Intraorbital penetrating and retained foreign bodies –a neurosurgical case series

“…The advantage of MRI over CT is that surrounding inflammation or hematoma can be better delineated from the foreign body, especially on T2 sequences where it appears hyperintense (24). 3D reconstructions based on CT or MRI are particularly useful for foreign body localization and surgical planning (5,11).…”