Oculocerebral perforating trauma by foreign objects: diagnosis and surgery

Two unusual cases of perforating oculocerebral trauma by foreign bodies treated surgically are reported. Both were caused by industrial accidents. In the first a nail shot from a nail gun ricocheted off the target and crossed the right eyeball and the posterior wall of the orbit, lodging in the homolateral temporal lobe. In the second case a metal fragment expelled by an agricultural machine penetrated the left maxillary sinus, crossed the floor of the orbit, the eyeball and the roof of the orbit and lodged in the homolateral frontal lobe. After accurate neuroradiological examination the patients were operated using simultaneous transcranial and transorbital access. In our opinion this is the only approach which can minimize the risk of infection which is so dangerous in this type of trauma. The functional and aesthetic results, which were very satisfactory in both cases, seem to confirm the correctness of this approach.