Clinically asymptomatic intracranial injury caused by transorbital penetration of a projectile foreign body
Marijan Kovačić, Ivan Kovačić, Ivica Francišković, Maja Grgec Dragičević
Objective: In this paper, we present a rare case of transorbital intracranial penetrating injury, our diagnostic procedures, treatment, and final outcome. Patient and methods: A 38-year-old patient on triage examination had right periorbital injury, bruising and swelling of the upper eyelid, minor skin laceration, and joint prolapse. He had no loss of consciousness, vision or neurological deficit. Based on the data that he had suffered an orbital injury when mowing the plants, in addition to clinical examination we performed radiological processing. As the first method of radiological diagnostics we performed computed tomography. A metal artifact was found stuck in the medial part of the roof of the orbit with a partial penetration into the intracranium. After tetanus prophylaxis and antibiotic administration we proceeded to remove the foreign body. External transorbital pathway above the entrance wound was selected. We exposed the orbital part of the foreign body, and without applying brute force removed a piece of wire. The resulting perforated bone defect was closed with bone wax. Results: The patient’s recovery was rapid, with no neurological or ocular outbursts. We did not notice the presence of early and late complications of the operation. Conclusion: This serious, sometimes life threatening injury, can have a successful outcome if a multidisciplinary approach is used to diagnose early, perform targeted diagnostic imaging, quality surgical planning and postoperative treatment.