title: Violence-related periorbital trauma with a retained foreign body: a case report.
abstract: BACKGROUND
  Orbital fracture usually occurs as a result of blunt orbital and facial trauma and may involve ocular injuries. International studies on orbital floor fracture show several differences in epidemiology, diagnostic criteria, surgical treatment modalities, and complication rates; therefore, any comparison should be made with caution. Here we describe an unusual case involving a 19-year-old man with violence-related periorbital trauma, wherein a foreign body (a plastic pen cap) traversed the median wall of the maxillary sinus and penetrated the lower turbinate.
  
  
  METHODS
  A 19-year-old Caucasian man was referred to our department with localized pain and swelling in the left suborbital region following a physical fight in May 2014. A clinical examination revealed no abnormalities in his eyeballs or eye movement, palpation of the orbital contour revealed no fractures, and ophthalmological evaluation showed no evidence of diplopia. A computed tomography scan revealed fractures in the left orbital floor, periorbital tissue herniation without muscular entrapment and left maxillary hemosinus were observed. A hypodense soft tissue mass was lodged in the left orbital floor, which extended to the median wall of the maxillary sinus and penetrated the left lower turbinate. Surgical exploration of the foreign body was conducted, revealing the foreign body to be a pen cap.
  
  
  CONCLUSIONS
  History or clinical examination alone may be inadequate to raise the suspicion of a retained periorbital foreign body in a situation of orbital region trauma. Computed tomography is important for the evaluation of periorbital injuries, especially because it could reveal the presence of a foreign body. Periorbital foreign bodies can be observed distinctly on computed tomography, which remains the most sensitive study and should be the first imaging modality in such cases.
authors.affiliation: Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Dell'Aversana
authors.affiliation: Oral Surgery Division, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Marenzi
authors.affiliation: Ear, Nose and Throat Department, Second University of Naples, Via Pansini, 5, 80131, Naples, Italy. pasquale.piombino@unina2.it.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Piombino
authors.affiliation: Ear, Nose and Throat Department, Second University of Naples, Via Pansini, 5, 80131, Naples, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Testa
authors.affiliation: Maxillofacial Department, University of Sassari, Viale San Pietro, 43/B 07100, Sassari, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: De Riu
authors.affiliation: Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Abbate
authors.affiliation: Division of Maxillofacial Surgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Califano
authors.affiliation: Oral Surgery Division, Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Pansini, 5, 80131, Naples, Italy.
authors.forename: Gilberto
authors.initials: G
authors.lastname: Sammartino
mesh_terms: D000328:Adult; D005547:Foreign Bodies / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D008297:Male; D008443:Maxillary Sinus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D009917:Orbital Fractures / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014754:Violence