Treatment of orbitocranial penetrating injuries caused by non-firearm foreign bodies: a report of 20 cases

Abstract

Objective To provide data support and experiences for the management of orbitocranial penetrating injuries by summarizing 20 patients with orbitocranial penetrating injury. Methods Twenty patients with orbitocranial penetrating injury caused by non-firearm foreign bodies admitted to the Nerve Trauma Center, Huashan Hospital, Fudan University from January 2004 to January 2014 were analyzed retrospectively. The clinical data of the patients included age, sex, Glasgow coma scale (GCS) on admission, time from injury to surgery, foreign body type, surgical approach, type of injury and scope, hospitalization time and visual acuity, as well as major complications affecting prognosis. They were followed up from 3 months to 2 years. The prognosis of patients was assessed by the Glasgow outcome scale (GOS). Results There are 18 males and 2 females, their age ranged from 9 to 66 years old(mean 31.7 years). GCS was 15~14 in 19 patients(95%) , 12 in 1 patients (5%). All the injuries were caused by accidents, 11 of them were metallic foreign bodies, 4 were wooden foreign bodies, 3 were bamboo products, and 2 were plastic foreign bodies. CT findings revealed that the orbital entrances of 8 foreign bodies were located at the inner canthi, 8 were located at the lower eyelids, 2 were located at outer canthi, and 2 were located at the upper eyelids. Of the 20 patients, 10 foreign bodies entered from superior orbital fissure into skull. The 8 intracranial entries were located at the great wing of sphenoid, and 2 were located at anterior clinoid process. Five patients were operated via bifrontal transbasal approach and 15 were operated via pterional approach. Five patients complicated with intracranial infection and they eventually recovered and discharged. The GOS grade V was in 18 cases and grade Ⅳwas in 2 cases. Conclusions The early detection of intracranial injury and correct surgical treatment will significantly improve the prognosis of the patients with non-firearm orbitocranial penetrating injuries. Key words: Craniocerebral trauma; Head injuries, penetrating; Orbitocranial injury; Foreign bodies