Dunn Ian F, Kim Dong H, Rubin Peter A, Blinder Russell, Gates Jonathan, Golby Alexandra J
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Neurosurgery. 2009 Aug;65(2):E383-4; discussion E384. doi: 10.1227/01.NEU.0000347474.69080.A1.
Intraorbital wooden foreign bodies--usually from a low-velocity puncture--are elusive and demand a low threshold for further imaging. In patients with traumatic injuries, orbital and intracranial air from fractures may be present, and it is particularly easy to overlook a wooden fragment
A 53-year-old equestrian was kicked in the face by the rear hoof of a horse. The event was captured on video by her husband. Although no obvious entry point in and around the eye was observed, her ocular examination was notable for superior orbital fissure syndrome and increasing intraocular pressure in the left eye. Closer inspection revealed a 5-mm laceration above her superior lid margin; imaging revealed a foreign body at the orbital apex with apparent communication with the cranial vault.
We proceeded with cranio-orbital exploration because of the risk of continued ocular damage in the setting of increasing intraocular pressure and the potential for infection of both the eye and the intracranial space from a suspected foreign body. A 3.0 cm x 0.5 cm fragment was found lodged in the orbital apex and removed.
The patient recovered well after surgery and a course of antibiotics and has returned to riding. This case report presents an algorithm for approaching cranio-orbital foreign objects of unclear identity and the favorable outcomes that may be achieved.
眶内木质异物——通常由低速穿刺所致——难以发现，需要保持较低的进一步影像学检查阈值。在创伤患者中，骨折导致的眶内和颅内积气可能存在，木质碎片尤其容易被忽视。
一名53岁的骑手被马的后蹄踢中面部。该事件被她的丈夫用视频记录了下来。尽管在眼睛及其周围未观察到明显的入口点，但她的眼部检查显示左眼存在眶上裂综合征且眼压升高。仔细检查发现其上睑缘上方有一处5毫米的裂伤；影像学检查显示眶尖有一个异物，且与颅顶明显相通。
鉴于眼压升高可能导致持续的眼部损伤，以及疑似异物可能导致眼内和颅内感染，我们进行了颅眶探查。发现一块3.0厘米×0.5厘米的碎片嵌顿在眶尖并将其取出。
患者术后经抗生素治疗恢复良好，现已恢复骑马。本病例报告提出了一种处理身份不明的颅眶异物的方法以及可能取得的良好结果。
