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Multidisciplinary Management of an Orbitocranial Penetrating Injury by a Pencil in a Paediatric Patient - A Case
Karim Tewfik1, Claudia Covelli2, Manuela Rossini1
1Paediatric Head and Neck Department, Paediatric Maxillo-Facial Surgery Unit, ASST Spedali Civili of Brescia, Italy.
Insights
Orbitocranial penetrating injuries from pencils can cause optic nerve damage. Prompt angiography and surgical intervention are crucial for managing intracranial vessel damage and preventing hemorrhage.
Area of Science:
- Pediatric Neurosurgery
- Ophthalmology
- Vascular Surgery
Background:
- Orbitocranial penetrating injuries, often from common objects like pencils, pose significant risks to children.
- These injuries can lead to severe complications including ocular damage, brain lesions, intracranial hemorrhage, and infections.
Observation:
- A 7-year-old child sustained an orbitocranial penetrating injury from a pencil, with initial diagnosis of the foreign body and optic nerve damage missed.
- Computed tomography (CT) scan with contrast revealed the pencil fragment and a critical lesion in the left internal carotid artery.
Findings:
- The patient underwent angiography to address the carotid artery lesion and prevent hemorrhage, followed by craniotomy for pencil extraction and removal of fragments.
- Despite treatment, the child experienced permanent vision loss in the left eye.
Implications:
- This case underscores the importance of thorough imaging and vascular assessment in orbitocranial penetrating injuries.
- Preoperative angiography is mandatory when intracranial vessel damage is suspected or identified in such cases to guide surgical management and improve outcomes.
Rationale:
Orbitocranial penetrating injuries can accidentally occur in children while handling pencils and can cause severe sequelae such as ocular damage, brain lesion, intracranial haemorrhage, and infections.
Patient Concerns:
We report the case of a 7-year-old child with an orbitocranial penetrating injury by a pencil, initially gone undetected, that caused a direct damage to the optic nerve.
Diagnosis:
Computed tomography scan with contrast detected the foreign body and the presence of a lesion of the left internal carotid artery.
Treatment:
Angiography was performed to treat the vascular lesion and to prevent haemorrhage. Subsequently, a craniotomy was performed to assist the extraction of the pencil from the entry wound and to remove residual fragments.
Outcomes:
Left eye vision was lost. The 1-year follow-up was uneventful.
Take-Away Lessons:
Operative angiography is mandatory before the surgical extraction of the orbitocranial penetrating injury in case of documented intracranial vessel damage.
