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Intraorbital Branch

Intraorbital Branch A 2-YEAR-OLD boy fell from a second-floor balcony into a bush (Figure 1), and a branch lacerated the left upper eyelid and entered the orbit (Figure 2). Findings from computed tomography showed a radiolucent round object in the inferior orbit, with indentation and superior displacement of the globe (Figure 3). The object penetrated the infratemporal fossa via a fracture of the lateral wall (Figure 4). The entrance tract in the inferior fornix was explored (Figure 5). Multiple pieces of leaf and bark were removed and irrigated from the tract using antibiotic solution, the lid laceration was repaired, and a drain was placed (Figure 6). Findings from fundus examination showed only mild inferior commotio retinae. Intravenous cefuroxime sodium was administered for 1 week. With no signs of infection, he was given oral antibiotics and discharged from the hospital. Four years later, he had a visual acuity of 20/20 OU, full motility, and a well-healed eyelid. Figure 1. View LargeDownload Large intraorbital branch splits the left upper eyelid and extends into the orbit. Figure 2. View LargeDownload Profile of intraorbital branch injury. Figure 3. View LargeDownload Coronal computed tomographic scan reveals round radiolucent orbital foreign body indenting and displacing the left eye superiorly. Figure 4. View LargeDownload Axial computed tomographic scan shows the wood foreign body fracturing the inferolateral wall and extending into the infratemporal fossa. Figure 5. View LargeDownload After removal of the foreign body, the lacerated left upper eyelid and inferior fornix entrance tract are identified. Figure 6. View LargeDownload The eyelid laceration has been repaired, the entrance tract explored and cleaned, and a Penrose drain placed. Comment Orbital wood foreign bodies can be associated with serious injuries, including fractures, ocular damage, and intracranial perforation,1 and are often difficult to detect on computed tomographic scans.2,3 Retained wood foreign bodies can result in prolonged suppuration with a draining fistula, panophthalmitis, foreign body granuloma, and brain abscess.4,5 This case illustrates the importance of removing all foreign material from the entrance tract to prevent these complications. Facial fractures are uncommon in children owing to the comparatively large cranium and forehead, the relative elasticity of the developing bones, and the more protected environment of children.6 In this patient, the large branch expanded the orbit, fractured the inferolateral wall, and entered the infratemporal fossa. Fortunately, it did not result in either permanent ocular damage or intracranial penetration. Accepted for publication January 9, 1999. This investigation was supported in part by Research to Prevent Blindness Inc, New York, NY. Reprints: Thomas E. Johnson, MD, 900 NW 17th St, Miami, FL 33136 (e-mail: tjohnson@bpei.med.miami.edu). References 1. Specht CSVarga JHJalali MMEdelstein JP Orbitocranial wooden foreign body diagnosed by magnetic resonance imaging: dry wood can be isodense with air and orbital fat by computed tomography. Surv Ophthalmol. 1992;36341- 344Google ScholarCrossref 2. Green BFKraft SPCarter KD et al. Intraorbital wood: detection by magnetic resonance imaging. Ophthalmology. 1990;97608- 611Google ScholarCrossref 3. Cartwright MJKurumety URFrueh BR Intraorbital wood foreign body. Ophthal Plast Reconstr Surg. 1995;1144- 48Google ScholarCrossref 4. Tuppurainen KMantyjarvi MPuranen M Wooden foreign particles in the orbit: spontaneous recovery. Acta Ophthalmol Scand. 1997;75109- 111Google ScholarCrossref 5. Brock LTanenbaum HL Retention of wooden foreign bodies in the orbit. Can J Ophthalmol. 1980;1570- 72Google Scholar 6. McGraw BLCole RR Pediatric maxillofacial trauma: age-related variations in injury. Arch Otolaryngol Head Neck Surg. 1990;11641- 45Google ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 2000 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.118.4.590
Publisher site
See Article on Publisher Site

Abstract

A 2-YEAR-OLD boy fell from a second-floor balcony into a bush (Figure 1), and a branch lacerated the left upper eyelid and entered the orbit (Figure 2). Findings from computed tomography showed a radiolucent round object in the inferior orbit, with indentation and superior displacement of the globe (Figure 3). The object penetrated the infratemporal fossa via a fracture of the lateral wall (Figure 4). The entrance tract in the inferior fornix was explored (Figure 5). Multiple pieces of leaf and bark were removed and irrigated from the tract using antibiotic solution, the lid laceration was repaired, and a drain was placed (Figure 6). Findings from fundus examination showed only mild inferior commotio retinae. Intravenous cefuroxime sodium was administered for 1 week. With no signs of infection, he was given oral antibiotics and discharged from the hospital. Four years later, he had a visual acuity of 20/20 OU, full motility, and a well-healed eyelid. Figure 1. View LargeDownload Large intraorbital branch splits the left upper eyelid and extends into the orbit. Figure 2. View LargeDownload Profile of intraorbital branch injury. Figure 3. View LargeDownload Coronal computed tomographic scan reveals round radiolucent orbital foreign body indenting and displacing the left eye superiorly. Figure 4. View LargeDownload Axial computed tomographic scan shows the wood foreign body fracturing the inferolateral wall and extending into the infratemporal fossa. Figure 5. View LargeDownload After removal of the foreign body, the lacerated left upper eyelid and inferior fornix entrance tract are identified. Figure 6. View LargeDownload The eyelid laceration has been repaired, the entrance tract explored and cleaned, and a Penrose drain placed. Comment Orbital wood foreign bodies can be associated with serious injuries, including fractures, ocular damage, and intracranial perforation,1 and are often difficult to detect on computed tomographic scans.2,3 Retained wood foreign bodies can result in prolonged suppuration with a draining fistula, panophthalmitis, foreign body granuloma, and brain abscess.4,5 This case illustrates the importance of removing all foreign material from the entrance tract to prevent these complications. Facial fractures are uncommon in children owing to the comparatively large cranium and forehead, the relative elasticity of the developing bones, and the more protected environment of children.6 In this patient, the large branch expanded the orbit, fractured the inferolateral wall, and entered the infratemporal fossa. Fortunately, it did not result in either permanent ocular damage or intracranial penetration. Accepted for publication January 9, 1999. This investigation was supported in part by Research to Prevent Blindness Inc, New York, NY. Reprints: Thomas E. Johnson, MD, 900 NW 17th St, Miami, FL 33136 (e-mail: tjohnson@bpei.med.miami.edu). References 1. Specht CSVarga JHJalali MMEdelstein JP Orbitocranial wooden foreign body diagnosed by magnetic resonance imaging: dry wood can be isodense with air and orbital fat by computed tomography. Surv Ophthalmol. 1992;36341- 344Google ScholarCrossref 2. Green BFKraft SPCarter KD et al. Intraorbital wood: detection by magnetic resonance imaging. Ophthalmology. 1990;97608- 611Google ScholarCrossref 3. Cartwright MJKurumety URFrueh BR Intraorbital wood foreign body. Ophthal Plast Reconstr Surg. 1995;1144- 48Google ScholarCrossref 4. Tuppurainen KMantyjarvi MPuranen M Wooden foreign particles in the orbit: spontaneous recovery. Acta Ophthalmol Scand. 1997;75109- 111Google ScholarCrossref 5. Brock LTanenbaum HL Retention of wooden foreign bodies in the orbit. Can J Ophthalmol. 1980;1570- 72Google Scholar 6. McGraw BLCole RR Pediatric maxillofacial trauma: age-related variations in injury. Arch Otolaryngol Head Neck Surg. 1990;11641- 45Google ScholarCrossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Apr 1, 2000

Keywords: fractures,eyelid,foreign bodies,lacerations,orbit,infratemporal fossa,eye,fornix (brain)

References

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