[Transoral Penetrating Cranial Injury by a Chopstick:A Case Report]

Area of Science:

• Pediatric Neurosurgery
• Trauma Surgery
• Medical Imaging

Background:

• Intracranial injuries from foreign objects in the oral cavity are rare but carry high mortality in children.
• Management is complicated when the penetrating object is removed, obscuring injury depth and location.

Observation:

• A 26-month-old girl sustained an oral cavity injury from a plastic chopstick penetrating her palate.
• Initial CT scan showed retropharyngeal air but no intracranial abnormality.
• The child developed bacterial meningitis and right hemiparesis.

Findings:

• Despite neurological deficits suggesting a medullary lesion, MRI and other imaging failed to locate the intracranial injury.
• A high-signal path on MRI indicated penetration from the nasopharynx to the dura.
• The path's trajectory suggested a small lesion in the right lateral medulla oblongata, potentially affecting the corticospinal tract.

Implications:

• This case underscores the difficulty in diagnosing subtle intracranial lesions after penetrating oral trauma.
• Advanced imaging may not always detect small lesions, necessitating clinical correlation.
• Early recognition and advanced imaging techniques are crucial for managing such rare pediatric neurotrauma cases.