Transnasal intracranial injury caused by the penetration of a vegetative foreign body through the nose: diagnosis and treatment
Autori:
Marijan Kovačić, Ivan Kovačić, Zoran Kranjčec, Mateja Veršić
Sažetak
Nenamjerne prodorne intrakranijske transnazalne ozljede prava su rijetkost. U ovom je prikazu slučaja opisana jedna takva ozljeda nastala pri slučajnom padu odraslog muškarca na stabljiku trske tijekom šetnje. Osim njezina bizarnog nastanka, ova povreda je dodatno zanimljiva zbog odsutnosti otvorene rane mekih česti lica i skrivenoga intranazalnog stranog tijela, što predstavlja jedinstven slučaj. Intrakranijska ozljeda je dijagnosticirana CT snimanjem glave, a strano tijelo identificirano je endoskopskim pregledom nosne šupljine. Kirurški zahvat uklanjanja stranog tijela izvršen je kombiniranim vanjskim – transetmoidalnim i endoskopsko-transnazalnim
pristupom. Defekt koštane strukture, desne kribriformne ploče i moždane ovojnice rekonstruiran je pedikularnim nazoseptalnim režnjem. Oporavak unesrećenika nakon operacijskog zahvata bio je potpun i nije bilo intrakranijskih niti ekstrakranijskih komplikacija.
Summary
Unintentional penetrating intracranial transnasal injuries are a real rarity. This case report describes one such injury that occurred when an adult male accidentally fell on a reed stalk during a walk. In addition to its bizarre occurrence, this injury is further interesting due to the absence of an open facial wound and a hidden intranasal foreign body which is a unique case. Intracranial injury was diagnosed by CT imaging of the head, and a foreign body identified by endoscopic examination of the nasal cavity. Foreign body removal surgery was
performed with combined external transethmoid and endoscopic transnasal approach. Defect of bone structure, right cribriform plate and meninges was reconstructed with pedicular nasoseptal flap. The recovery of the casualty after surgery was complete and there were neither intracranial nor extracranial complications.
