Residual foreign body inflammation caused by a lumber beam penetrating the facial region: a case report

Abstract

Penetrating wounds to the face are cosmetically devastating and can be life-threatening. If the foreign body causing the penetrating wound is a piece of wood, small remnants might be left behind after the initial treatment. A 33-year-old male patient presented to the emergency center after a piece of lumber pierced his face as a passenger in a traffic accident. The patient's vital signs were stable, and emergency surgery was performed to remove the foreign body and repair the soft tissue. No noteworthy complications were seen after open reduction and internal fixation of the facial bone fractures. Seven months after the accident, the patient underwent scar revision along with full-thickness skin grafting for post-traumatic scars. After the surgery, pus-like discharge which was not previously present was observed, and the graft did not take well. A residual foreign body, which was the cause of graft failure, was found on computed tomography and the remaining foreign body was removed through revision surgery. The patient is receiving outpatient follow-up without any complications 6 months after surgery. This case demonstrates the importance of performing a careful evaluation to avoid missing a residual foreign body, especially if it is of wooden nature.

Keywords: Case reports; Foreign bodies; Wood; Wounds, penetrating.

Fig. 1

A Photograph of the patient at the time of admission to the emergency room. A 5×5×100 cm beam of lumber pierced the face.

Fig. 2

Computed tomography (CT) and simple radiography images of the patient before and after foreign body removal surgery. (A) Simple radiography image before surgery. (B) Axial CT image before the surgery. (C) Simple radiography image after surgery. (D) Axial CT image after surgery showing the residual foreign body, which was confused with an air shadow (yellow arrow).

Fig. 3

Cicatricial contracture with ectropion of the right lower eyelid.

Fig. 4

Photographs of the residual foreign body. (A) On an enhanced facial computed tomography image, an area of high attenuation was observed, corresponding to a residual foreign body in the right masticator space (yellow arrow). An abscess pocket of about 3 cm in size was seen (white arrowhead). (B) Residual foreign body removed.