Morgan Ryan D, Chintagunta Anila, Psaromatis Kirie M, Vojtkofsky Nicholas A, Baronia Benedicto, Belirgen Muhittin
School of Medicine, Texas Tech University Health Sciences Center Lubbock, 3601 4th St, Lubbock, TX 79430, USA.
School of Medicine, Texas College of Osteopathic Medicine, Fort Worth, TX, USA.
Radiol Case Rep. 2023 Jul 29;18(10):3560-3564. doi: 10.1016/j.radcr.2023.07.026. eCollection 2023 Oct.
The foramen ovale is a structure that allows for the extracranial passage of multiple significant intracranial structures, most notably the mandibular branch of the trigeminal nerve (CN V). Here we report the case of a 12-year-old male who presented to the emergency department (ED) with a two-day history of nausea and emesis and a one-day history of altered mental status. Prior to presentation, he started speaking only Spanish, which was unusual because he primarily speaks English. He was also showing signs of absence seizures. Computed Tomography (CT) showed his orthodontic wire had migrated and was entering his skull through the foramen ovale, terminating within the inferior temporal lobe. Associated with the wire was an intraparenchymal hemorrhage. Imaging indicated the sparing of the internal carotid artery and its major branches, suggesting the hemorrhage was likely venous in nature. The wire was then safely removed with no complications. Same day and follow-up neurologic exams all demonstrated no deficit in CN V or any of the other surrounding structures. To our knowledge, this is the first case described in the literature in which a foreign object penetrated the skull floor through the foramen ovale.
卵圆孔是一个允许多个重要颅内结构在颅外通过的结构，最显著的是三叉神经（CN V）的下颌支。在此，我们报告一例12岁男性病例，该患者因恶心呕吐2天、精神状态改变1天就诊于急诊科。在就诊前，他开始只说西班牙语，这很不寻常，因为他主要说英语。他还表现出失神发作的迹象。计算机断层扫描（CT）显示他的正畸钢丝移位，正通过卵圆孔进入颅骨，终止于颞下叶内。与钢丝相关的是脑实质内出血。影像学显示颈内动脉及其主要分支未受影响，提示出血可能为静脉性。随后安全取出钢丝，无并发症。当日及后续的神经学检查均显示CN V或任何其他周围结构无功能缺损。据我们所知，这是文献中描述的首例异物通过卵圆孔穿透颅底的病例。
