Violence-related periorbital trauma with a retained foreign body: a case report

Abstract

Background: Orbital fracture usually occurs as a result of blunt orbital and facial trauma and may involve ocular injuries. International studies on orbital floor fracture show several differences in epidemiology, diagnostic criteria, surgical treatment modalities, and complication rates; therefore, any comparison should be made with caution. Here we describe an unusual case involving a 19-year-old man with violence-related periorbital trauma, wherein a foreign body (a plastic pen cap) traversed the median wall of the maxillary sinus and penetrated the lower turbinate.

Case presentation: A 19-year-old Caucasian man was referred to our department with localized pain and swelling in the left suborbital region following a physical fight in May 2014. A clinical examination revealed no abnormalities in his eyeballs or eye movement, palpation of the orbital contour revealed no fractures, and ophthalmological evaluation showed no evidence of diplopia. A computed tomography scan revealed fractures in the left orbital floor, periorbital tissue herniation without muscular entrapment and left maxillary hemosinus were observed. A hypodense soft tissue mass was lodged in the left orbital floor, which extended to the median wall of the maxillary sinus and penetrated the left lower turbinate. Surgical exploration of the foreign body was conducted, revealing the foreign body to be a pen cap.

Conclusions: History or clinical examination alone may be inadequate to raise the suspicion of a retained periorbital foreign body in a situation of orbital region trauma. Computed tomography is important for the evaluation of periorbital injuries, especially because it could reveal the presence of a foreign body. Periorbital foreign bodies can be observed distinctly on computed tomography, which remains the most sensitive study and should be the first imaging modality in such cases.

Fig. 1

Clinical examination. Moderate edema and ecchymosis of the suborbital left region, bruising of the left lower eyelid, and skin sutures at the outer third of the orbital frame can be observed

Fig. 2

a–b Axial and coronal views of computed tomography images. A left orbital floor fracture and a foreign body localized in the medial portion of the left orbital floor, which extends upward to the left lower turbinate, can be observed

Fig. 3

Intraoperative view of the surgical site. A foreign body is identified as a plastic pen cap measuring 0.5 cm in diameter

Fig. 4

Soft tissue healing 3 months after surgery

Fig. 5

a–b Computed tomography image obtained 3 months after surgery. The reconstructed orbital floor and resolution of the left hemosinus are observed