Wooden foreign body in the skull base: How we missed it?

Wooden foreign body in the skull base: How we missed it?

World Neurosurg. 2016 Jun 21;

Authors: Jusué-Torres I, Burks SS, Levine CG, Bhatia RG, Casiano R, Bullock MR

Abstract
BACKGROUND: Timely detection of intraorbital and skull base wooden foreign bodies is crucial. Wooden foreign bodies are difficult to detect on imaging. The radiologist may not identify them in up to two thirds of initial scans and can miss wooden foreign bodies in almost one third of total cases.
CASE DESCRIPTION: A 66 year-old lady sustained a penetrating injury through her left upper eyelid with a small-tree branch. The branch was immediately removed in the field, and she was provided with prompt medical care at a local hospital. Initial CT scan diagnosis was "post-traumatic sinusitis" and treated empirically with Vancomycin and Piperacillin/tazobactam. On the eighth day post injury, she developed progressive swelling and pain of her eyelid with left trigeminal/supraorbital numbness and complete left opthalmoplegia. A new CT scan showed an open "track" from the region of the left upper orbit/superior rectus, to the contralateral sphenoid sinus which raised suspicion for a retained foreign body. Further imaging confirmed the suspicion. Endoscopic sinus surgery was performed with extraction of the wooden object and evacuation of the left orbital infection.
CONCLUSIONS: This case indicates that intraorbital and skull base wooden foreign bodies are elusive; demanding a high index of suspicion from both the clinicians and radiologists to identify retained material in the setting of ocular or sinus trauma. For better identification of wooden foreign bodies bone windows on CT should have a width of -1000 HU with a soft tissue window level of -500 HU.

PMID: 27354291 [PubMed - as supplied by publisher]

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