- Neurosurgery Unit, Department of Surgery, Edward Francis Small Teaching Hospital,
- Department of Surgery, Edward Francis Small Teaching Hospital,
- Opthalmology Unit, Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia.
John Nute Jabang
Opthalmology Unit, Department of Surgery, Edward Francis Small Teaching Hospital, Banjul, Gambia.
DOI:10.25259/SNI_204_2020Copyright: © 2020 Surgical Neurology International This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
How to cite this article: John Nute Jabang, Lamin Dampha, Binta Sanyang, Charles Adeyemi Roberts, Bakary Ceesay. Management of a large intraorbital wooden foreign body: Case report. 20-Jun-2020;11:158
How to cite this URL: John Nute Jabang, Lamin Dampha, Binta Sanyang, Charles Adeyemi Roberts, Bakary Ceesay. Management of a large intraorbital wooden foreign body: Case report. 20-Jun-2020;11:158. Available from: https://surgicalneurologyint.com/?post_type=surgicalint_articles&p=10088
Background: Intraorbital foreign bodies are a global injury and occur with a frequency of one in six orbital injuries; however, intraorbital wooden foreign bodies are uncommon. Intraorbital wooden foreign bodies predominantly affect the male population with a mean age ranging from 21 to 22 years. The diagnosis of intraorbital wooden foreign bodies depending on their size can be challenging on imaging and if not removed early the risk of infection is high.
Case Description: A 23-year-old motorcyclist presented to the ER following a collision with a donkey cart carrying wood 3 h before presentation. Examination revealed an acutely ill-looking man in painful distress with a right supraorbital laceration associated with ipsilateral ptosis and periorbital edema. There was a retained intraorbital wooden foreign body. Computed tomography scan showed evidence of both an intraorbital bone fragment and a wooden foreign body. Surgery was done 3rd day of admission before which vision has declined with only perception to light. Only the wooden foreign body was removed. Evolution was favorable with recovery of vision and improvement of the ptosis.
Conclusion: The management of intraorbital wooden foreign bodies demands a multidisciplinary approach after a thorough history, examination, and imaging. Treatment of choice is timely and meticulous removal of the foreign body to avoid infection and other associated complications.
Keywords: Computer tomography scan, Intraorbital wooden foreign body, Magnetic resonance imaging, Orbital cellulitis, Orbital trauma, Visual acuity
Intraorbital foreign bodies (IOFBs) are a global injury and occur with a frequency of one in six orbital injuries; however, intraorbital wooden foreign bodies are uncommon.[
A case of a 23 years old who presented to the ER after 3 h of an RTA. He was riding a motorbike and collided with a donkey cart that was carrying wood. On examination, he was in acute painful distress with GCS of 15. He had right supraorbital laceration with associated ptosis and ipsilateral periorbital edema and conjunctival ecchymosis. There was a wooden foreign body [
An IOFB is defined as an object located inside the bony orbital walls, posterior to the orbital septum but outside the ocular globe,[
IOFBs represent an uncommon pathology in neurosurgical practice. Larger neurosurgical case series that report the characteristics in terms of diagnosis and treatment of different categories of foreign bodies, according to their material and location in the orbit, as a reference for neurosurgeons who encounter this pathology is very rare.[
The most frequently manifesting clinical symptoms of traumatic optic neuropathy were orbital pain, diplopia, and decreased vision or visual field defect. The pathognomonic sign was the presence of an open or closed entry wound. In our cases, the entry wound was located primarily on the eyelids.[
Different imaging modalities are available for these types of trauma. The utility of X-rays aside from the identification of intraorbital metallic foreign bodies is more or less insignificant.[
The surgical approach, for removal, depends on the nature of the body, its location (anterior or posterior orbit), and associated complications (infections, optic nerve lesions, or compression, and lesions to the extraocular nerve or intraorbital blood vessels). As an unusual case both for the Neurosurgery Unit and the Ophthalmology unit (in fact first of its kind), a series of interdisciplinary consultations and planning were convened before we finally decided to operate the 3rd day on admission, thus delaying the surgery. Suffice to say that this delay in surgery further increases the risk of infection in patients with intraorbital wooden foreign body. The surgical approach was chosen according to the location of the foreign body, the foreign body was extracted by the use of the entry route in our patient as it was visible and easily accessible after circumferential dissection done by a combined neurosurgery and ophthalmology team.[
Rates of infection in the context of IOWFB are reported as high as 64%, antibiotics are essential, especially as culture of the excised IOWFB is frequently polymicrobial. As a general recommendation, empirical broad-spectrum antibiotics should be administered in each case, and antifungal treatment should be used in cases of wooden foreign bodies.[
The management of intraorbital wooden foreign bodies demands a multidisciplinary approach after a thorough history, examination, and imaging. Their diagnosis, depending on their size and duration can pose a challenge as they are not easily identifiable on CT scan. The high risk of bacterial and fungal infection of intraorbital wooden foreign bodies are dependent on their duration as a result, meticulous removal of the foreign body so as to avoid such complications is the treatment of choice.
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