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Transorbital penetrating injury: case series, review of the literature, and proposed management algorithm.

Abstract：

:Transorbital penetrating injury (TPI), an uncommon subset of head trauma, requires prompt multidisciplinary surgical intervention. While numerous case reports appear in the literature, there is a lack of discrete recommendations for initial evaluation, surgical intervention, and postoperative care of patients with TPI. A retrospective review of 4 cases of TPI at the University of Michigan Health System was undertaken to assess for diagnosis, treatment, and follow-up. In addition, a PubMed search using the terms "penetrating orbital trauma," "penetrating orbital injury," "transorbital penetration," and "transorbital penetrating injury" were used to search for articles discussing the presentation and management of penetrating orbital trauma. All 4 of the patients at the University of Michigan underwent focused physical examination performed by a multidisciplinary trauma team followed by dedicated maxillofacial and head CT scanning. The patients' treatments varied, depending on the mechanism and extent of the injury. An analysis of the case series presented here as well as other published cases suggests an algorithm for diagnosis and treatment for patients with TPI, which includes focused evaluation, diagnostic imaging with maxillofacial CT scanning, and management of the injury that focuses on the path of penetration and the presence of the foreign body in situ at the time of presentation. Magnetic resonance imaging is indicated in patients who have indwelling wooden foreign bodies. Angiography should be performed in patients with suspected vascular injury. Treatment decisions should be made by a multidisciplinary team with input from neurosurgery, ophthalmology, otolaryngology, and maxillofacial surgery.

journal_name

J Neurosurg

journal_title

Journal of neurosurgery

authors

Schreckinger M,Orringer D,Thompson BG,La Marca F,Sagher O

doi

10.3171/2010.8.JNS10301

subject

Has Abstract

pub_date

2011-01-01 00:00:00

pages

53-61

issue

1

eissn

0022-3085

issn

1933-0693

journal_volume

114

pub_type

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