Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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June 11, 2015
Orbital Wooden Foreign Body
- Background: Although transcranial intra-orbital penetration by a wooden foreign body is unusual, it carries a high mortality rate due to secondary intracranial infections caused by micro-organisms in the wood. These can cause CSF leaks, panophthalmitis, and abscess.
- Key Diagnostic Features: Detection of intraorbital wooden foreign bodies may be difficult, especially in cases of apparently minor trauma.
- On CT they appear as a hypodense structure with nearly the same density as air. Broader window settings allow the visualization of the inner structure of the wooden foreign body.
- On MRI, both dry and fresh wood have been described as hypointense relative to intraorbital fat on all spin-echo sequences, providing a good contrast between intraorbital fat and wood.
- Treatment In general, metal and glass are well tolerated and may be left in situ in selected cases. On the other hand, organic matter like wood is poorly tolerated, as it elicits an intense inflammatory reaction and therefore has to be removed urgently. A team comprising a neurosurgeon, an ophthalmologist, and a plastic surgeon should participate in the removal of large foreign bodies such as the one presented. A careful inspection of the anterior fossa floor has to be conducted to rule out CSF leaks. Appropriate postoperative management includes culture of the wound (or foreign body if removed) and administration of antibiotic(s). Tetanus toxoid must be administered according to the vaccination status.
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