Transorbital penetrating intracranial injury by a chopstick

Abstract

A 38-year-old man fell from a chair with a chopstick in his hand. The chopstick penetrated his left eye. He noticed pain, swelling, and numbness around his left eye. On physical examination, a linear wound was noted at the medial aspect of the left eyelid. Noncontrast computed tomography (CT) study showed a linear hypodense structure extending from the medial aspect of the left orbit to the occipital bone, suggesting a foreign body. This foreign body was hyperdense relative to normal parenchyma. From a CT scan with 3-dimensional reconstruction, the foreign body was found to be passing through the optic canal into the cranium. The clear plastic chopstick was withdrawn without difficulty. The patient was discharged home 3 weeks after his surgery. A treatment plan for a transorbital penetrating injury should be determined by a multidisciplinary team, with input from neurosurgeons and ophthalmologists.

Keywords: Craniocerebral trauma; Foreign body; Orbit; Penetrating.

Fig. 1

The remarkably swollen left eyelid and a small laceration at upper medial epicanthal area of the left eye are presented.

Fig. 2

A, B and C : A noncontrast CT study shows a linear hyperdense structure extending from the medial aspect of the left orbit to the occipital bone, suggesting a foreign body that was hyperdense relative to normal parenchyma. D and E : A CT scan with 3-dimensional reconstruction shows foreign body going through the optic canal into the cranium.

Fig. 3

Intraoperative photograph shows the plastic chopstick, at about 14 cm in length. Chopstick was removed surgically.

Fig. 4

A : Axial T2-weighted MR image shows a hyperintense linear lesion injury from a chopstick. B : CISS image revealed that left facial nerve was not injured. MR : magnetic resonance, CISS : constructive Interference in Steady State.