Download An Extremely Long Lasting Foreign Body in the Orbital Floor

Case Report
DOI: 10.5152/TurkJPlastSurg.2016.1937
An Extremely Long Lasting Foreign Body in the Orbital Floor
Melike Oruç, Yüksel Kankaya, Koray Gürsoy, Nezih Sungur, Mustafa Gürhan Ulusoy, Uğur Koçer
Clinic of Plastic, Reconstructive and Aesthetic Surgery, Ankara Training and Research Hospital, Ankara, Turkey
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Abstract
Maxillofacial traumas and resultant orbital foreign bodies are problematic. These types of injuries can be overlooked easily, and they can
cause severe complications. In this clinical report, a patient with an intraorbital foreign body (glass) secondary to a maxillofacial trauma
that occurred 20 years ago is presented.
Keywords: Orbita, foreign body, maxillofacial, glass
INTRODUCTION
Foreign bodies in the maxillofacial region or in the orbit are often the result of traumatic incidents and are often seen in adults. The types
of foreign bodies most frequently encountered in the orbital region are metallic objects and chunks of glass.1 Intraorbital foreign bodies
are usually the result of high-energy injuries but can also be identified after minor injuries with no significant history.2 Because an untreated foreign body can give rise to severe complications, all patients who present with maxillofacial trauma should be examined with
care and skepticism.
The presented case describes a patient who was treated for an intraorbital foreign body secondary to maxillofacial trauma. Presentation
of this case, in which the patient had a history of a 20-year-old maxillofacial trauma, intends to draw the reader’s attention to the fact that
foreign bodies occurring subsequent to a maxillofacial trauma can easily go unnoticed and in turn lead to functional losses.
CASE PRESENTATION
The 29-year-old patient presented to our outpatient clinic with complaints of diplopia, limited movement of the left eye, stiffness palpable inferolateral to the left eye, and a recently emerged redness on the left lower eyelid. The patient’s history revealed that laceration had
occurred, extending from the nasal dorsum to the intraorbital region, after he had fallen onto a glass surface approximately two decades
ago. A stiff, immobile mass inferolateral to the left orbit, irregularity on the lower orbital rim, and limited upward movement of the left eye
were identified during the physical examination. A computed tomography (CT) was planned and results showed a sizable foreign body
extending along the orbital base inferolateral to the left orbit (Figure 1). After ophthalmologic consultations, the patient was operated on
under general anesthesia. Informed consent was obtained from the patient as required for the procedure. In the exploration performed
through a left subciliary incision, irregularity and a healed fracture line was identified in the left orbital base. A foreign body (glass chunk)
of approximately 1.5 × 2 cm was extracted from the orbital base (Figures 2, 3). The patient had a smooth recovery, and no problems were
encountered in the postoperative period.
DISCUSSION
Orbital injuries caused by foreign bodies are problematic. Because trauma history can easily be overlooked, both diagnosis and treatment
can be challenging. Although cases that have been diagnosed after up to 1.5 years of injury are reported in the literature3, to the best of
Correspondence Author: Dr. Melike Oruç
E-mail: [email protected]
©Copyright by 2016 Turkish Society of Plastic Reconstructive, and Aesthetic Surgery - Available online at www.turkjplastsurg.com.
Received: 05.12.2014
Accepted: 30.12.2014
Oruç et al / Orbital Foreign Body
Turk J Plast Surg 2016; 24(2): 87-9
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Figure 1. Preoperative CT image of the glass chunk in the left orbit
our knowledge, no case has been reported where a foreign
body has remained in the orbit for as long as almost two decades, as observed in the present case. Careful anamnesis,
detailed physical examination, and a high level of skepticism
combined with the appropriate imaging techniques is vital
for accurately diagnosing foreign bodies in the orbit.
Figure 2. Intraoperative view of the glass chunk being extracted from the orbit
Unextracted orbital foreign bodies can lead to severe functional and structural disorders. Orbital fractures and meningitis concomitant with loss of vision and possible brain damage
inflicted by intraorbital foreign bodies have been reported in
the literature.3,4 The most frequent complications triggered by
orbital foreign bodies include proptosis, chronic fistula, orbital abscess, cellulitis, and eye muscle or optic nerve wounds.3
Diagnosis of orbital foreign bodies is often difficult and depends on the content and size of the foreign body.5 Metallic
objects and glass chunks are the most frequently encountered orbital foreign bodies and rarely cause inflammatory
reactions, unless they contain copper. On the contrary, although less often identified, organic foreign bodies usually
create an inflammatory response, and unless extracted from
the body, can become chronic with severe sequelae.5,6
Direct radiography, ultrasound imaging, CT, and magnetic
resonance imaging (MRI) can be used for diagnosing orbital
foreign bodies. Conventional radiography should be definitely requested for all maxillofacial traumas after the initial physical examination. Sometimes, however, a radiograph may not
be effective enough for identifying foreign bodies. Axial and
coronal CT can provide detailed information about a maxillofacial trauma and can be useful in the localization of a foreign body. On the other hand, despite being effective against
high-density materials such as glass or metal, CT is less sensitive to foreign bodies of low-density such as organic items.5
MRI can also be used in these types of injuries, however,
should not be used in cases that are likely to contain metallic
foreign bodies because metallic objects can inflict irreversible
orbital injuries in magnetic fields. Despite displaying negative
Figure 3. The extracted glass chunk of approximately 1.5 × 2 cm
imaging results, exploration can be beneficial if a history supporting the presence of an orbital foreign body is applicable.
The size, localization, and content of the material are important in the decision regarding the exploration and extraction
of the foreign body. Foreign bodies can be easily removed
from the subcutaneous plane, the nasal passage, and the
maxillary or the frontal sinuses, but cases where the body is
localized in posterior regions such as the sphenoidal sinuses or the posterior orbital region are not good candidates for
surgical extraction. Foreign bodies localized in posterior regions present an increased risk of optic neuropathy and other
similar complications following a surgical procedure.7
CONCLUSION
Maxillofacial injuries should be evaluated in terms of a possible
foreign body penetration. Many cases and radiology studies
addressing orbital foreign bodies are presented in the literature. All of these reports emphasize the potential detrimental
effects of foreign bodies. Another important aspect stressed
Turk J Plast Surg 2016; 24(2): 87-9
in these reports is the latency time, which may be hours to
months. However, no other case is reported in the literature to
involve a foreign body that has gone unnoticed for such a long
time as was in our case. Therefore, we believe that the presentation of the present case is valuable in that it emphasizes the
importance of identifying intraorbital foreign bodies and preventing long-term sequelae in maxillofacial injuries.
Informed Consent: Written informed consent was obtained from patient who participated in this case.
Oruç et al / Orbital Foreign Body
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Author Contributions: Concept – M.O.; Design – M.O., Y.K.; Supervision – N.S., M.G.U.; Literature Search – M.O., K.G.; Writing Manuscript
– M.O., Y.K.; Critical Review – U.K., N.S., M.G.U.
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Conflict of Interest: No conflict of interest was declared by the authors.
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Financial Disclosure: The authors declared that this study has received no financial support.
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