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小儿患者铅笔所致眶颅穿透伤的多学科管理——病例报告

Multidisciplinary Management of an Orbitocranial Penetrating Injury by a Pencil in a Paediatric Patient - A Case Report.

作者信息

Tewfik Karim, Covelli Claudia, Rossini Manuela, Peta Caterina, Burlini Dante

机构信息

Paediatric Head and Neck Department, Paediatric Maxillo-Facial Surgery Unit, ASST Spedali Civili of Brescia, Italy.

Services Department, Pathology Unit, ASST del Garda, Brescia, Italy.

出版信息

Ann Maxillofac Surg. 2022 Jan-Jun;12(1):72-75. doi: 10.4103/ams.ams_33_22. Epub 2022 Aug 16.

DOI:10.4103/ams.ams_33_22
PMID:36199462
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9527848/
Abstract

RATIONALE

Orbitocranial penetrating injuries can accidentally occur in children while handling pencils and can cause severe sequelae such as ocular damage, brain lesion, intracranial haemorrhage, and infections.

PATIENT CONCERNS

We report the case of a 7-year-old child with an orbitocranial penetrating injury by a pencil, initially gone undetected, that caused a direct damage to the optic nerve.

DIAGNOSIS

Computed tomography scan with contrast detected the foreign body and the presence of a lesion of the left internal carotid artery.

TREATMENT

Angiography was performed to treat the vascular lesion and to prevent haemorrhage. Subsequently, a craniotomy was performed to assist the extraction of the pencil from the entry wound and to remove residual fragments.

OUTCOMES

Left eye vision was lost. The 1-year follow-up was uneventful.

TAKE-AWAY LESSONS: Operative angiography is mandatory before the surgical extraction of the orbitocranial penetrating injury in case of documented intracranial vessel damage.

摘要

原理

儿童在使用铅笔时可能意外发生眶颅穿透伤，并可导致严重后遗症，如眼部损伤、脑损伤、颅内出血和感染。

患者情况

我们报告一例7岁儿童因铅笔导致眶颅穿透伤的病例，最初未被发现，该伤对视神经造成了直接损伤。

诊断

增强计算机断层扫描检测到异物以及左颈内动脉存在病变。

治疗

进行血管造影以治疗血管病变并预防出血。随后，进行开颅手术，以协助从伤口取出铅笔并清除残留碎片。

结果

左眼视力丧失。1年的随访无异常情况。

经验教训

如果有颅内血管损伤的记录，在手术取出眶颅穿透伤之前必须进行手术血管造影。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adcf/9527848/da0899ef1603/AMS-12-72-g006.jpg
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https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adcf/9527848/e093d3f41ca4/AMS-12-72-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adcf/9527848/b6f5e7822a55/AMS-12-72-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adcf/9527848/da0899ef1603/AMS-12-72-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adcf/9527848/4205edd542b0/AMS-12-72-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adcf/9527848/23409119183c/AMS-12-72-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adcf/9527848/beef30045072/AMS-12-72-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/adcf/9527848/e093d3f41ca4/AMS-12-72-g004.jpg
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本文引用的文献

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Ann Med Surg (Lond). 2021 Oct 14;71:102937. doi: 10.1016/j.amsu.2021.102937. eCollection 2021 Nov.
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Orbitocranial Penetrating Injury With Multiple Vessel Invasion in an Infant: A Case Report and Literature Review.婴儿眶颅穿透伤伴多血管受累：一例报告及文献复习
Front Neurol. 2020 Nov 12;11:591431. doi: 10.3389/fneur.2020.591431. eCollection 2020.
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Classification of orbitocranial wooden foreign body penetration injuries: what to do when they violate the intracranial space? A systematic review.
眼眶颅木质异物穿透伤的分类：当它们侵犯颅内空间时该怎么办？系统评价。
J Neurosurg Sci. 2020 Apr;64(2):190-199. doi: 10.23736/S0390-5616.19.04793-3. Epub 2019 Nov 13.
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A survey of incidental ocular trauma by pencil and pen.铅笔和钢笔所致眼外伤的调查
Int J Ophthalmol. 2018 Oct 18;11(10):1668-1673. doi: 10.18240/ijo.2018.10.15. eCollection 2018.
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Orbital and Orbitocranial Trauma From Pencil Fragments: Role of Timely Diagnosis and Management.铅笔碎片导致的眼眶及眶颅创伤：及时诊断与处理的作用
Am J Ophthalmol. 2017 Aug;180:46-54. doi: 10.1016/j.ajo.2017.05.018. Epub 2017 May 26.
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Cerebrovascular complications of transorbital penetrating intracranial injuries.
Ulus Travma Acil Cerrahi Derg. 2015 Jul;21(4):271-8. doi: 10.5505/tjtes.2015.48839.
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