Adakal Ousseini, Abdoulaye Maman Bachir, Traore Hassane Amadou, Maikassoua Mamane, Iro Salissou, Sani Rachid
Department of Surgery and Surgical Specialties, Reference Hospital of Maradi, Niger; Faculty of Health Sciences, Dan Dicko Dankoulodo University of Maradi, Niger.
Department of Surgery and Surgical Specialties, Regional Hospital of Maradi, Niger.
Int J Surg Case Rep. 2022 Jan;90:106727. doi: 10.1016/j.ijscr.2021.106727. Epub 2021 Dec 23.
Orbital impalement is a serious and potentially life-threatening trauma if the brain or vessels at the base of the skull are affected. The authors report the results and aftermath of the management of a case of post-traumatic retention of an intra-orbital metallic foreign body.
A 5-year-old boy was struck by a motorcycle while crossing a road. His head struck the handlebars of the motorcycle with a left facial-orbital impact point. The examination revealed a foreign body penetrating the orbit at the level of the left upper eyelid with limitation of adduction. The radiological assessment confirmed the intra-orbital presence of the foreign body with probable fracture of the inner wall of the eyeball. Surgical exploration through the palpebral wound revealed an intact eyeball and an incarceration of the medial rectus muscle by a fracture of the internal wall. After delicate and meticulous removal of the foreign body, hemostasis was ensured and the wound was sutured. The evolution was satisfactory, without sequelae or visual prejudice.
Imaging, i.e. a CT scan and a standard X-ray, is necessary to evaluate the lesions before adapting a therapeutic attitude. The choice of the approach for extraction must meet two cardinal concerns: extraction of the foreign body and minimal dissection or manipulation of the noble structures of the eye and its adnexa.
Intra-orbital foreign bodies are rare but potentially serious. The type of the foreign substance, its intra-orbital extension and related lesions, as well as the extraction process, all influence the prognosis.
如果眼眶穿通伤影响到脑或颅底血管，那将是一种严重且可能危及生命的创伤。作者报告了一例创伤后眶内金属异物存留病例的治疗结果及后续情况。
一名5岁男孩在过马路时被一辆摩托车撞倒。他的头部撞到摩托车车把，左面部眼眶处为撞击点。检查发现有一异物从左上眼睑水平穿入眼眶，导致内收受限。影像学评估证实眶内存在异物，且可能伴有眼球内壁骨折。通过睑部伤口进行手术探查发现眼球完整，内侧直肌因内壁骨折而嵌顿。在精细小心地取出异物后，确保了止血并缝合了伤口。病情进展令人满意，未出现后遗症或视力损害。
在采取治疗措施之前，进行影像学检查，即CT扫描和标准X线检查，对于评估损伤情况是必要的。异物取出方法的选择必须满足两个主要关注点：取出异物以及尽量减少对眼部及其附属器等重要结构的分离或操作。
眶内异物虽罕见但可能很严重。异物的类型、其在眶内的延伸范围及相关损伤，以及取出过程，都会影响预后。
