title: Nonmissile Penetrating Injury to the Head: Experience with 17 Cases.
abstract: BACKGROUND
  Penetrating nonmissile injuries to the head are far less common than missile penetrating injuries. Here we describe our experience in managing 17 cases of nonmissile injury to the head, likely the largest such series reported to date. We also highlight the surgical steps and techniques used to remove in situ objects (including weapons) in the penetrating wounds that have not been described previously.
  
  
  METHODS
  We conducted a retrospective study of cases of nonmissile, low-velocity penetrating injuries of the head managed in our department. The recorded data of patients with penetrating head injuries were studied for the cause of the injury, type of object, type and extent of penetration, Glasgow Coma Scale score on admission, other clinical issues, evaluation and assessment, interval from penetration to operation, surgical steps and notes, difficulty during the operation, major and minor complications, follow-up, and ultimate outcome.
  
  
  RESULTS
  Our 17 cases included 6 cases of accidental penetration and 11 cases of penetration as the result of violence. Weapons and other foreign objects causing injury included a teta (a pointed metal weapon with a wooden handle and a barb near the tip, used for hunting and fishing) in 4 cases, a dao (a sharp metal cutting instrument with a wooden handle used for cutting vegetables, fish, meat, bamboo, wood, etc.) in 3 cases, a bamboo stick in 3 cases, a metal rod in 2 cases, a knife in 2 cases, a sharp stone in 1 case, a metal steam chamber cover in 1 case, and a long peg in 1 case. GCS on admission was between 13 and 15 in 15 cases. Only 1 patient exhibited limb weakness. Four patients with an orbitocranial penetrating injury had 1-sided vision loss; 2 of these patients had orbital evisceration, and 1 of these patients died. In 14 patients, the foreign object was in situ at presentation and was removed surgically. Computed tomography scan and plain X-ray of the head were obtained in all patients. Postoperatively, 2 patients (11.7%) needed support in the intensive care unit but died early after surgery. One patient developed late osteomyelitis. The remaining patients were doing well at the most recent follow-up.
  
  
  CONCLUSIONS
  The presenting picture of nonmissile penetrating injury to head may be daunting, but these cases can be managed with very good results with proper (clinical and radiologic) evaluation and simple neurosurgical techniques.
authors.affiliation: National Institute of Neurosciences, Dhaka Medical College and Hospital, Dhaka, Bangladesh. Electronic address: forhadchowdhury74@yahoo.com.
authors.forename: Forhad H
authors.initials: FH
authors.lastname: Chowdhury
authors.affiliation: Department of Neurosurgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
authors.forename: Mohammod Raziul
authors.initials: MR
authors.lastname: Haque
authors.affiliation: National Institute of Neurosciences, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
authors.forename: Zahed
authors.initials: Z
authors.lastname: Hossain
authors.affiliation: National Institute of Neurosciences, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
authors.forename: Noman Khaled
authors.initials: NK
authors.lastname: Chowdhury
authors.affiliation: National Institute of Neurosciences, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
authors.forename: Sarwar Murshed
authors.initials: SM
authors.lastname: Alam
authors.affiliation: Department of Neurosurgery, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
authors.forename: Mainul Haque
authors.initials: MH
authors.lastname: Sarker
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D005547:Foreign Bodies / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D020197:Head Injuries, Penetrating / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Foreign body; Nonmissile penetrating head injury; Orbitocranial penetrating injury