Retrieval of projectile foreign bodies from the paranasal sinuses and skull base

Penetrating trauma to the paranasal sinuses and skull base with retained foreign bodies represents a unique challenge for head and neck surgeons. Management of these injuries is complicated by associated injuries and the proximity to vital neurovascular structures. This study was designed to review the clinical experience with retained sinonasal and skull base projectile foreign bodies at a single academic tertiary care institution.

A retrospective review of patients who suffered penetrating trauma to the head with retained metallic foreign bodies in the paranasal sinuses and/or skull base between January 2002 and August 2011 was performed at a single academic medical center.

There were 599 patients who suffered penetrating trauma to the head and neck, with 13 patients having retained metallic foreign bodies in the sinuses and/or skull base, mostly bullets or nails. Ten patients underwent urgent (n = 5) or delayed (n = 5) removal of foreign bodies accessible without compromise of adjacent structures either through an endoscopic or open approach. Three patients had multiple foreign bodies that were not removed. Three patients experienced traumatic cerebrospinal fluid fistula managed with either conservative measures (n = 2) or intraoperative repair at the time of foreign body retrieval (n = 1). All patients received prophylactic antibiotic coverage. No patients suffered infectious complications such as sinusitis from retained foreign bodies.

Although not all retained foreign bodies after penetrating trauma to the head require removal, those that are safely accessible and at risk for infectious complications should be recovered. The timing and approach of retrieval are dictated by the clinical scenario.