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Intraorbital wooden foreign bodies: A retrospective study of 30 cases
Chandana Chakraborti1, Nabanita Barua2, Juhi Gupta3
1Department of Ophthalmology, Bankura Sammilani Medical College, Bankura, West Bengal, India.
Purpose:
Intraorbital Wooden foreign bodies (IOrbWFB) can remain trapped or undetected in imaging, leading to potentially serious complications. We aimed to study 30 consecutive cases of intraorbital wooden foreign body (IOrbWFB), their clinical profile, and management in a tertiary care hospital.
Methods:
A retrospective observational study of 30 cases at our center from March 2020 to December 2024 was conducted. Data were collected from hospital records and reviewed after obtaining institutional ethical clearance.
Results:
Out of the 30 cases, 14 patients presented with features of orbital cellulitis, and seven cases presented with orbitocutaneous fistula (OCF). The time interval between injury and initial presentation ranged from 1 day to 7 years. A total of 16 cases presented within a week of injury, among which four cases presented early within 24 hours. A foreign body was detected in 17 cases by computed tomography (CT), but 10 cases were misdiagnosed on the initial CT scan. Magnetic resonance imaging (MRI) was performed in 13 cases, including suspicious cases and when symptoms were not resolving. Eight patients underwent surgery multiple times, of which two cases underwent surgery three times, and five cases underwent surgery twice.
Discussion:
The size, location, and number of IOrbWFB should be evaluated thoroughly using imaging studies. They are often misdiagnosed on imaging; hence, a high index of suspicion should be maintained in cases with a history of trauma, regardless of the time interval between presentation and trauma. Primary surgery should be performed with proper exposure, and the foreign body should be removed intact to have a better outcome. The study will help to avoid missed diagnosis and misdiagnosis of IOrbWFB.
Conclusion:
Thorough history taking, detail examination, appropriate imaging and proper surgical planning are essential is all cases of suspected IOrbWFB.
Insights
Intraorbital wooden foreign bodies (IOrbWFB) are often misdiagnosed on imaging, leading to complications. A high suspicion and thorough evaluation are crucial for timely diagnosis and effective management of these challenging cases.
Area of Science:
- Ophthalmology
- Medical Imaging
- Trauma Surgery
Background:
- Intraorbital wooden foreign bodies (IOrbWFB) pose diagnostic challenges due to potential for entrapment and delayed detection.
- Missed or delayed diagnosis of IOrbWFB can lead to severe complications such as orbital cellulitis and orbitocutaneous fistula.
Purpose of the Study:
- To analyze the clinical profile and management of 30 intraorbital wooden foreign body cases.
- To highlight diagnostic difficulties and emphasize optimal management strategies for IOrbWFB.
Main Methods:
- Retrospective observational study of 30 consecutive IOrbWFB cases.
- Data collected from hospital records between March 2020 and December 2024.
- Inclusion of computed tomography (CT) and magnetic resonance imaging (MRI) findings.
Main Results:
- 14 cases presented with orbital cellulitis; 7 with orbitocutaneous fistula.
- Significant delay in presentation noted, ranging from 1 day to 7 years.
- 10 cases were misdiagnosed on initial CT scans; multiple surgeries were required in 8 patients.
Conclusions:
- A high index of suspicion is vital for diagnosing IOrbWFB, irrespective of the time since injury.
- Thorough imaging evaluation, including CT and MRI, is essential to avoid misdiagnosis.
- Proper surgical planning and complete foreign body removal are critical for favorable outcomes.
