Clinical diagnosis and treatment of intraorbital wooden foreign bodies

Abstract

Purpose: The intraorbital wooden foreign body is often misdiagnosed or missed on computed tomog- raphy (CT) scan, due to the invisible or unclear images. The residual foreign bodies often occur during surgical removal. The clinical manifestations, imaging features and treatment of intraorbital wooden foreign bodies were discussed in this study.

Method: We retrospectively analyzed 14 cases of intraorbital wooden foreign bodies managed at our hospital between January 2007 and May 2015. All patients underwent orbital CT examination before surgery, and surgery was performed under general anesthesia with orbital wound debridement and suture, as well as exploration and removal of wooden foreign bodies.

Results: At first, 11 cases underwent removal of foreign bodies, including 1 case with incomplete removal and then receiving a secondary surgery. Foreign bodies were not found in three cases with preoperative misdiagnosis and orbital MRI found residual foreign bodies in the orbit. Operations were performed via primary wound approach in eight cases, conjunctival approach in two cases, and anterior orbitotomy in four cases. Postoperatively, one case was complicated with eye injuries, three cases with ocular muscle injuries, eight cases with visual loss, and eight cases with orbital abscess. The length of foreign bodies ranged from 1.8 cm to 11.0 cm. The maximum of four foreign bodies were removed at the same time.

Conclusion: Because the imaging of orbital wooden foreign bodies is complex and varied, MRI should be combined when they are invisible on CT scan. At the same time injuries trajectory and clinical mani- festations of patients should be taken into account. Surgical exploration should be extensive and thor- ough, and foreign bodies and orbital abscess must be cleared.

Fig. 1

A: Wooden sticks in the orbit; B: Swelling in the right upper eyelid without skin wound; C: Swelling in the left upper eyelid with skin wound; D: Foreign bodies moved intraoperatively.

Fig. 2

Multiple intraocular foreign bodies (A–C). CT scan showing the strip low-density shadow in the lateral orbit, multiple small flake low-density shadow around foreign bodies, compressed globe and surrounding soft tissue swelling. A low-density shadow seen outside muscle cone of the upper orbit, closely correlated with superior rectus muscle (A: sagittal plane, B: coronal plane, C: transection). CT images showing the foreign body with a length of 3.2 cm in the upper orbit and low-density strip shadow, around which the inflammatory liquid leaked. Superior rectus muscle not shown clearly (D: sagittal plane, E: coronal plane, F: transection). CT scan showing the lesion in muscle cone behind left eyeball with uneven density (G: transection, H: sagittal plane, I: coronal plane).

Fig. 3

The foreign body outside muscle cone of the upper orbit, with long T₁ and T₂ signals and the size about 0.4 × 0.3 cm, around which there was the abscess showing the flake long T₁ and T₂ signals. Right superior rectus muscle moved down by compression (A: T₁W₁, B: T₂W₁).