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. 2018:50:21-24.
doi: 10.1016/j.ijscr.2018.07.012. Epub 2018 Jul 25.

Removal of large impacted foreign body from the base of the skull through submandibular access: A multidisciplinary approach

Hatem H Al-Ahmady  1 , Mohamed El Sayed  2 , Ahmed Fereir  3 , Amr Ekram  4 , Kareem Mousa  5
Affiliations

Removal of large impacted foreign body from the base of the skull through submandibular access: A multidisciplinary approach

Hatem H Al-Ahmady et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: This report describes the removal of a missed impacted large piece of a glass that reaches the infra-temporal region after a traumatic injury at the submandibular area.

Case presentation: A nine year-old patient presented with a limited mouth opening (0.5 cm). Initial examination showed a scar of an old trauma in the submandibular area two months prior to presentation. The radiographic study showed a large knife-shaped foreign body with its tip at the infra-temporal region, and its base at the submandibular region. Further multi-slice computed tomography with angiography was done that showed close proximity of the foreign body to the branches of the external carotid artery; maxillary, lingual and facial branches. The foreign body was removed via extra-oral approach through the old scar of the past injury under general anesthesia. Dissection, exposure of the external carotid artery and preparing it for emergency ligation, were done before extraction of the foreign body. The patient's mouth opening increased to 2.5 cm without any complications.

Conclusion: Cut wounds in the face should not be repaired in the primary care without detailed history, systematic examination and proper investigations.

Keywords: External carotid artery; Foreign body; Infra-temporal cone beam computed tomography; Skull base; Submandibular.

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Figures

Fig. 1
Fig. 1
Showing foreign body extended from hyoid bone inferiorly to infra temporal region superiorly.
Fig. 2
Fig. 2
Coronal cut of multi-slice computed tomography with angiography showing the left maxillary artery (red arrow) between the upper part of the foreign body and the ramus of the mandible. The lower part of the foreign body is related to the left lingual artery (white arrow) medially and the left facial artery (blue arrow) laterally.
Fig. 3
Fig. 3
Drawn incision line across the old scar.
Fig. 4
Fig. 4
A. Foreign body in place (between the two retractors). B. Large piece of glass after removal.
Fig. 5
Fig. 5
Postoperative scar in the follow-up period.
See this image and copyright information in PMC

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