Extraction of a Penetrating Nasocranial Foreign Body via Transnasal Endoscopic Approach

A 42-year-old male presented to our hospital with right ocular pain, diplopia, and difficulty opening his right eye. Three days earlier, while pulling up a fishing rod, a sinker struck his face. Since then, he developed decreased vision in his left eye and visited a local ophthalmologist the following day, where a retinal hemorrhage in the left eye was diagnosed. Two days later, he developed dull pain in his right eye and revisited the ophthalmologist on the third day after the injury. A computed tomography (CT) scan revealed a foreign body in the paranasal sinus, and he was subsequently referred to our hospital. Upon initial examination at our hospital, complete ophthalmoplegia and right-sided ptosis were observed. CT scan revealed a metallic foreign body in the paranasal sinus, penetrating the orbit and middle cranial fossa. Considering that the foreign body was a metallic sinker, magnetic resonance imaging (MRI) was not performed. Cerebral angiography revealed no direct injury to the internal carotid artery. The foreign body was extracted using a transnasal endoscopic approach and was confirmed to be a fishing sinker. Postoperatively, intravenous steroids and antibiotic treatment were administered. Ophthalmoplegia and ptosis completely resolved.