Orbitocranial wooden foreign body: a pre-, intra-, and postoperative chronicle: case report.
OBJECTIVE
Intraorbital wooden foreign bodies--usually from a low-velocity puncture--are elusive and demand a low threshold for further imaging. In patients with traumatic injuries, orbital and intracranial air from fractures may be present, and it is particularly easy to overlook a wooden fragment


METHODS
A 53-year-old equestrian was kicked in the face by the rear hoof of a horse. The event was captured on video by her husband. Although no obvious entry point in and around the eye was observed, her ocular examination was notable for superior orbital fissure syndrome and increasing intraocular pressure in the left eye. Closer inspection revealed a 5-mm laceration above her superior lid margin; imaging revealed a foreign body at the orbital apex with apparent communication with the cranial vault.


METHODS
We proceeded with cranio-orbital exploration because of the risk of continued ocular damage in the setting of increasing intraocular pressure and the potential for infection of both the eye and the intracranial space from a suspected foreign body. A 3.0 cm x 0.5 cm fragment was found lodged in the orbital apex and removed.


CONCLUSIONS
The patient recovered well after surgery and a course of antibiotics and has returned to riding. This case report presents an algorithm for approaching cranio-orbital foreign objects of unclear identity and the favorable outcomes that may be achieved.
Dunn
Ian F
IF
Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Kim
Dong H
DH
Rubin
Peter A
PA
Blinder
Russell
R
Gates
Jonathan
J
Golby
Alexandra J
AJ
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001766:Blindness / Q000473:pathology / Q000517:prevention & control / Q000601:surgery; D001922:Brain Abscess / Q000188:drug therapy / Q000517:prevention & control; D035301:Cranial Fossa, Middle / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003399:Craniotomy / Q000379:methods; D019299:Decompression, Surgical / Q000379:methods; D005129:Eye Foreign Bodies / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D005260:Female; D020197:Head Injuries, Penetrating / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D020221:Optic Nerve Injuries / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009915:Orbit / Q000000981:diagnostic imaging / Q000293:injuries* / Q000473:pathology*; D009917:Orbital Fractures / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D013530:Surgical Wound Infection / Q000188:drug therapy / Q000517:prevention & control; D007507:Therapeutic Irrigation / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014934:Wood / Q000009:adverse effects* / Q000382:microbiology
D000900:Anti-Bacterial Agents