Transorbital Orbitocranial Penetrating Injury with an Iron Rod

Abstract

Transorbital orbitocranial penetrating injuries (TOPIs) are relatively rare, can be caused by high-speed projectile foreign bodies to low-energy trauma (which is rarer), and account for 24% of penetrating head injuries in adults and approximately 45% in children. We report an uncommon nonfatal case of TOPI where a 16-year-old male child sustained injury due to accidental penetration of metal bar into the forehead. A bicoronal flap was raised to remove the metal bar. The patient recovered well, had normal vision, and doing well at follow-up.

Keywords: iron rod; metal bar; transorbital penetrating intracranial injury.

Fig. 1

Clinical photograph showing curved iron rod entering just below the left supraorbital ridge and the distal is protruding the over the left side of forehead with intact skin over it.

Fig. 2

Radiograph of the skull lateral view showing the entry of the iron rod just below the orbital ridge and because of the “u” shape of the rod, it was apparently glided along the posterior wall of the frontal sinus and exited through the anterior frontal wall.

Fig. 3

(a–f) The radiographic findings were confirmed on CT scan and also it revealed that there were no intracranial injuries (please note the integrity of the posterior wall of the frontal sinus).

Fig. 4

(a, b) Sagittal and volume rendered images showing greater details of the trajectory of the iron rod and confirming the integrity of the posterior wall of the frontal sinus.

Fig. 5

Follow-up clinical photograph showing good cosmetic and functional results.