Craniofacial penetration by a wooden stick

Area of Science:

• Pediatric Neurosurgery
• Ophthalmology
• Emergency Medicine

Background:

• Penetrating craniofacial injuries, often from stick-like foreign bodies, pose a significant risk of morbidity, particularly in children.
• Accidental injuries can lead to severe complications if not managed appropriately.

Observation:

• A 5-year-old boy sustained a penetrating facial injury from a wooden stick entering through the left cheek.
• The foreign body traversed the orbital cavity and anterior skull base, penetrating 3cm into the frontal lobe.
• Initial neurological and vital signs were normal despite the deep intracranial penetration.

Findings:

• Successful removal of the wooden stick was achieved using an endoscopic transethmoidal approach, visualizing the anterior skull base.
• One-year follow-up revealed normal visual acuity and ocular motility, with no reported diplopia, tearing, or pain.

Implications:

• Penetrating facial injuries, even those appearing trivial externally, carry a high risk of neurological involvement.
• The cheek is an uncommon entry point for intracranial injuries, necessitating thorough assessment of the extent of damage.
• Endoscopic techniques offer a viable approach for managing complex intracranial foreign body retrieval.