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Case Reports
. 2024 Dec 19;87(2):924-928.
doi: 10.1097/MS9.0000000000002963. eCollection 2025 Feb.

Complex orbitocranial penetrating injury-managed through neuroplastic surgery - a rare case report and review of literature

Priti Udhay  1 , Varsha Coimbatore Sathyabal  2 , Om Saran Kodeeswaran  3 , Kodeeswaran M  4 , K P Priyadharshan  4 , Bipin Chaurasia  5
Affiliations
Case Reports

Complex orbitocranial penetrating injury-managed through neuroplastic surgery - a rare case report and review of literature

Priti Udhay et al. Ann Med Surg (Lond). .

Abstract

Introduction and importance: Orbitocranial penetrating injuries (OPI) are uncommon types of head injuries, accounting for about 0.04% of all head injuries. Foreign bodies penetrating the orbit and cranium cause fractures, leading to ophthalmic and neurological manifestations. These require a specialized treatment approach that mainly depends on the foreign body type, extent of injury, and potential complications. Management involves foreign body removal, reconstruction, and infection control.

Case details: We discuss a case of a 25-year-old male who presented with a penetrating cranio-orbital injury caused by a wooden stick through the left eye. The transorbital-transcranial wooden foreign body penetrated the orbital roof and temporal bone causing displacement of the orbital contents and extended intracranially into the temporal region. The management was done by a multidisciplinary approach consisting of a team of neurosurgeons and oculoplastic surgeons by extracting the foreign body and reconstruction.

Clinical discussion: No sound literature on the management of OPI by neuroplastic surgery is available.

Conclusion: This article highlights the importance of neuroplastic surgery for reconstructing complex fractures involving the cranio-orbital and craniofacial regions for improving patient outcomes, and preventing potential complications. This could potentially revolutionize the management of complex craniofacial abnormalities and a new era for neuro-reconstructive care.

Keywords: case report; intra-cranial injury; neuro-reconstruction; neuroplastic surgery; orbito-cranial penetrating injury; wooden foreign body.

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Conflict of interest statement

In compliance with the ICMJE uniform disclosure form, the authors declare no conflicts of interest.

Figures

Figure 1.
Figure 1.
Presentation of the patient in the emergency room with left-sided orbital edema and necrosis of the left eyelids and surrounding soft tissue.
Figure 2.
Figure 2.
Local examination of the patient’s left eye showing proptosis with scleral necrosis and soft tissue damage (red arrow). Necrosis of the surrounding eyelid and periorbital tissue (blue arrow).
Figure 3.
Figure 3.
Computed tomography revealed a wooden stick penetrating through the medial aspect of the left orbit and entering into the temporal lobe (red arrow).
Figure 4.
Figure 4.
The intra-cranial wooden stick measuring 8.7 cm after removal.
See this image and copyright information in PMC

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