[Foreign body removal from the orbit and skull base]

Owing to their rare incidence, foreign body injuries in the region of the orbit, skull base and skull have up to now mostly been treated in the literature by means of case reports. Here we present our experience and treatment regimen for ten patients we have treated during the last 3 years. In seven cases the foreign body was located in the orbit alone, whereas in three others the orbit and the frontal base were equally involved. Except for one case, the foreign material could be removed completely. Three patients suffered from partial or complete loss of vision and one patient developed a psychosyndrome during the follow-up period, but no late effects were registered in the remaining six cases. Before removing the foreign body and carefully reconstructing the accident, however, we strongly recommend the documentation of possible functional deficits, preferably by means of photography. CT is the method of choice for localising the foreign body, except for the depiction of wood particles. Here, sonography and MR should be performed. As the therapeutic approach, the cooperation of an interdisciplinary team of ophthalmogists, neuro- and maxillofacial surgeons seems mandatory. To avoid inflammation, the immediate removal of the foreign material is recommended in cases with considerable intracranial lesions: post-operative neurologic and intensive care monitoring should be provided. Treatment is completed by high-dose antibiotics, using CSF-soluble substances and, if necessary, anti-convulsives.