Traumatic Orbital Injury

Eidsness, Ryan B.; Coupal, Dustin; Kelly, Michael; Hattingh, Suzanne

doi:10.1097/01.ta.0000195455.15407.07

Cited by 10 publications

(8 citation statements)

References 4 publications

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“…[7][8][9][10][11][12] The finding of bilateral cranial nerve deficits in our patient was particularly significant as it suggested that the clamp had crossed the midline. A transcranial trajectory in penetrating injury has been identified as a predictor of increased morbidity and mortality.…”

Section: Discussionmentioning

confidence: 91%

Penetrating craniofacial trauma from a vice clamp: case report and discussion

Kjelland

Thirsk

2011

CJEM

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Penetrating craniofacial trauma, although uncommon, has a high potential for death or serious morbidity from injury to vital neurovascular structures. An in situ facial foreign body, particularly if large, presents significant challenges beyond safe and timely removal. Airway management, stabilization of the object, management of increased intracranial pressure, and identification of injuries to local structures are all issues that may require addressing. We present a case of penetrating facial trauma from a vice clamp, with an in situ foreign body, that illustrates several of these challenges and provides a forum for their discussion. RÉ SUMÉLe traumatisme craniofacial pé né trant, bien qu'il soit rare, pré sente un potentiel é levé de dé cè s ou de morbidité grave en raison de l'atteinte aux structures neurovasculaires vitales. Un corps é tranger in situ au niveau du visage, en particulier s'il est gros, pré sente des dé fis importants hormis son retrait sû r et en temps opportun. La prise en charge des voies respiratoires, la stabilisation de l'objet, la gestion de la pression intracrâ nienne accrue et la dé termination de la pré sence de lé sions aux structures locales sont autant de questions qui devront ê tre ré solues. Nous pré sentons un cas de traumatisme pé né trant au visage causé par un serre-joint, avec un corps é tranger in situ, qui illustre plusieurs de ces dé fis et fournit un forum pour la discussion.

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Section: Discussionmentioning

confidence: 91%

Penetrating craniofacial trauma from a vice clamp: case report and discussion

Kjelland

Thirsk

2011

CJEM

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“…MR imaging of the brain is useful in cases of wooden foreign body injury, since dry wood has a similar density to air and hydrated wood has a similar density to the soft tissue on a CT scan, making diagnosis potentially difficult6,18,23). Cerebral angiography, or other less invasive modalities including CT angiography or MR angiography, is indicated when there is evidence of possible vascular injury, either by the location and trajectory of the foreign body or by evidence of hematoma on CT scanning1,7,23). If there is suspicion for vascular injury, angiography should also be performed to evaluate for traumatic aneurysm, which can develop soon after a perforating injury5).…”

Section: Discussionmentioning

confidence: 99%

Transorbital Penetrating Intracranial Injury by a Chopstick

Shin

Kim

Kwak

et al. 2012

J Korean Neurosurg Soc

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A 38-year-old man fell from a chair with a chopstick in his hand. The chopstick penetrated his left eye. He noticed pain, swelling, and numbness around his left eye. On physical examination, a linear wound was noted at the medial aspect of the left eyelid. Noncontrast computed tomography (CT) study showed a linear hypodense structure extending from the medial aspect of the left orbit to the occipital bone, suggesting a foreign body. This foreign body was hyperdense relative to normal parenchyma. From a CT scan with 3-dimensional reconstruction, the foreign body was found to be passing through the optic canal into the cranium. The clear plastic chopstick was withdrawn without difficulty. The patient was discharged home 3 weeks after his surgery. A treatment plan for a transorbital penetrating injury should be determined by a multidisciplinary team, with input from neurosurgeons and ophthalmologists.

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“…12,29,45 Cerebral angiography, or other less invasive modalities including CT angiography or MR angiography, is indicated when there is evidence of possible vascular injury, either by the location and trajectory of the foreign body or evidence of hematoma on CT scanning. 5,13,45 When analyzing the trajectory of the foreign body on CT scanning, it is important to note whether the object traverses any areas of major vascular significance, including the ICA (especially within the cavernous sinus) and the anterior and middle cerebral arteries. If there is suspicion for vascular injury, angiography should also be performed to evaluate for traumatic aneurysm, which can develop soon after a penetrating injury.…”

Section: Diagnosis Of Tpimentioning

confidence: 99%

“…Nonmissile projectiles are defined as having an impact velocity of less than 100 m/second and cause injury by tissue laceration and maceration, while missile projectiles also cause injury via kinetic and thermal energy. 7 There have been many cases published of unusual foreign bodies that have penetrated intracranially via the orbit, including an umbrella tip, 5 eyeglass earpiece, 3,9,41 toilet brush handle, 14 fern, 19 toothbrush, 24 door key, 39 fork, 13,46 metal shelving bar, 10,43 and knitting needle. 8 Despite the large number of case reports, many of which have centered on neurosurgical intervention during foreign body removal, the neurosurgical literature lacks a concise review of the literature that provides multidisciplinary treatment guidelines for transorbital penetrating injuries.…”

mentioning

confidence: 99%

Transorbital penetrating injury: case series, review of the literature, and proposed management algorithm

Schreckinger¹,

Orringer

Thompson

et al. 2011

JNS

169

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Transorbital penetrating injury (TPI), an uncommon subset of head trauma, requires prompt multidisciplinary surgical intervention. While numerous case reports appear in the literature, there is a lack of discrete recommendations for initial evaluation, surgical intervention, and postoperative care of patients with TPI. A retrospective review of 4 cases of TPI at the University of Michigan Health System was undertaken to assess for diagnosis, treatment, and follow-up. In addition, a PubMed search using the terms "penetrating orbital trauma," "penetrating orbital injury," "transorbital penetration," and "transorbital penetrating injury" were used to search for articles discussing the presentation and management of penetrating orbital trauma. All 4 of the patients at the University of Michigan underwent focused physical examination performed by a multidisciplinary trauma team followed by dedicated maxillofacial and head CT scanning. The patients' treatments varied, depending on the mechanism and extent of the injury. An analysis of the case series presented here as well as other published cases suggests an algorithm for diagnosis and treatment for patients with TPI, which includes focused evaluation, diagnostic imaging with maxillofacial CT scanning, and management of the injury that focuses on the path of penetration and the presence of the foreign body in situ at the time of presentation. Magnetic resonance imaging is indicated in patients who have indwelling wooden foreign bodies. Angiography should be performed in patients with suspected vascular injury. Treatment decisions should be made by a multidisciplinary team with input from neurosurgery, ophthalmology, otolaryngology, and maxillofacial surgery.

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Traumatic Orbital Injury

Cited by 10 publications

References 4 publications

Penetrating craniofacial trauma from a vice clamp: case report and discussion

Penetrating craniofacial trauma from a vice clamp: case report and discussion

Transorbital Penetrating Intracranial Injury by a Chopstick

Transorbital penetrating injury: case series, review of the literature, and proposed management algorithm

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