Wardhana Donny Wisnu, Bal'afif Farhad, Nazwar Tommy Alfandy, Rosyada Amrina, Putro Wahju Sigit Tjahjono, Kholipah Anisa Nur
Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Universitas Brawijaya/Dr. Saiful Anwar General Hospital, Malang, East Java, Indonesia.
Surg Neurol Int. 2024 Nov 15;15:418. doi: 10.25259/SNI_668_2024. eCollection 2024.
Penetrating orbital trauma from a wooden foreign object is rare and challenging to identify, as it cannot be detected with a computed tomography (CT) scan. This report highlights the clinical presentation, diagnosis, and management of such a case.
A 19-year-old female experienced penetrating orbital trauma from a wooden object following a traffic accident. She intermittently visited the hospital with eye swelling and headache, without visible penetrating wounds on the palpebra. The swelling persisted for weeks, accompanied by increasing signs of ocular and cerebral infection. The suspicion of a non-metallic foreign body penetrating the brain was confirmed 3 months after the initial visit, delayed by the hidden entry wound between the eyelid and eyeball and orbital edema mimicking non-penetrating trauma. A multidisciplinary team managed the case. Procedures included debridement, retro-orbital exploration, retro-orbital abscess evacuation, and frontal basal trephination exploration, successfully removing the wooden object that had penetrated the medial orbit, frontal bone, and brain, along with cerebral abscess evacuation. Postoperative CT scans showed complete removal of the foreign object and successful abscess evacuation. The patient showed improvement in ocular symptoms, resolution of headaches, and no wound leakage. She was discharged on the 14 day after completing antibiotic treatment and having the dressing removed.
This case is notable for its rarity, high risk of misdiagnosis, and potentially fatal consequences if not promptly managed. We emphasize the importance of patient involvement in routine consultations, careful anamnesis, clinical examination, and a multidisciplinary approach for optimal outcomes.
木质异物导致的穿透性眼眶外伤较为罕见，且难以识别，因为计算机断层扫描（CT）无法检测到。本报告重点介绍了此类病例的临床表现、诊断和治疗。
一名19岁女性在交通事故后因木质物体导致穿透性眼眶外伤。她因眼部肿胀和头痛间歇性就医，眼睑未见明显穿透伤口。肿胀持续数周，伴有眼部和脑部感染迹象加重。初次就诊3个月后，因眼睑与眼球之间隐藏的伤口入口以及类似非穿透性外伤的眼眶水肿，证实了对非金属异物穿透脑部的怀疑。一个多学科团队对该病例进行了处理。手术包括清创、眶后探查、眶后脓肿引流以及额底部环钻探查，成功取出了穿透内侧眼眶、额骨和脑部的木质物体，并进行了脑脓肿引流。术后CT扫描显示异物已完全取出，脓肿引流成功。患者眼部症状改善，头痛缓解，无伤口渗漏。在完成抗生素治疗并拆除敷料后的第14天出院。
该病例因其罕见性、误诊风险高以及若不及时处理可能导致致命后果而备受关注。我们强调患者参与常规会诊、仔细问诊、临床检查以及采用多学科方法以实现最佳治疗效果的重要性。
