Removal of a giant wooden foreign body by subciliary incision and right fistulectomy: A case report
Author: Jose Tonatiuh Osorio-Vargas
Base Hospital / Institution: Fundación Hospital Nuestra Señora de la Luz IAP
Video presentation
Abstract ID: 25-488
Purpose
To describe, through a clinical case, the complexity of the diagnosis and clinical presentation of intraorbital wooden foreign bodies
Methods
We present the case of a 47-year-old male with medical history who presented with unexplained purulent discharge from the lower eyelid. The only medical history was a blunt force injury to the right orbit 4 months ago by a third person.Physical examination revealed a scar on the inner third of the right lower eyelid that did not involve the rim, with the presence of a cutaneous fistula with purulent discharge. In the strabological findings he presented limited right supraadduction, causing diplopia.The CT scan revealed a hyperdense image passing through the right maxillary sinus to the infraorbital region, in contact with the eyeball. A surrounding hyperdense image was shown associated with an inflammatory/infectious process.
Results
Removal of the intaorbital foreign body and right fistulectomy were proposed.Complete removal of the foreign body and fistulectomy resulted in complete improvement, with restoration of the patient’s architecture and improved clinical and symptomatic outcomes. By day 84 of follow-up, the patient was progressing well, with no signs of a persistent foreign body or persistent infection.
Conclusion
Diagnostic imaging is a difficult challenge.Diagnostic misses occur in up to 88% of cases, with confirmation occurring months or days after the injury.The gold standard is computed tomography.MRI is superior to CT in diagnosing small pieces of wood (T1-weighted imaging is recommended).An MRI should be performed if a wooden foreign body is suspected despite a negative CT scan.Conclusion: Intraorbital wooden foreign bodies cannot be completely rule out despite negative imaging studies. We suggest long-term follow-up and re-examination with imaging studies.
Additional Authors
| First name | Last name | Base Hospital / Institution |
|---|---|---|
| Ana Gabriela | Arce-Cerruto | Fundación Hospital Nuestra Señora de la Luz IAP |
| Ma. Veronica | Escalante-Gomez | Fundación Hospital Nuestra Señora de la Luz IAP |
