Transorbital−intracranial injury by a chopstick: three‐dimensional computed tomography

A 16-month-old boy fell down on the floorwith ametallic chopstick in his hand. On his admittance to our hospital, the chopstick was stuck into the medial aspectof the rightuppereyelid.Thepatient was crying, but his consciousness was normal. However, he was unable to open his right eye because of swelling of the lid and the foreign body penetration (Fig. 1). We were unable to perform further physical examinations due to the possibility of aggravating the injury. After sedation, CT scanning of the head was carried out for the evaluation of intracranial injury. A non-contrast CT study revealed a 2-cm transorbital intracranial chopstick tract from the skull base and band-like acute haematoma with surrounding oedema in the right frontal lobe. This haematoma measured about 8.7 3.3 15.7 mm and was located above the chopstick. Three-dimensional CT showed that the metallic chopstick had penetrated the right frontal brain parenchyma through the orbital roof (Fig. 2). Antibiotics were administered fromthe timeofadmission to prevent potential intracranial infection. The patient underwent an operation by ophthalmologists and neurosurgeons under general anaesthesia. Before the foreign body was removed, the upper eyelid wasgentlyopened tocheck thepupil reflex, which was found to be normal. A forced duction test revealed no limitation. A bicoronal incision was made from the superior margin of the zygomatic arch. The chopstick, buried in the frontal lobe, was carefully removed externally. The patient was alert after the operation without any sign of intracranial infection, and visual evoked potentials examination showed a normal response. Ocular or orbital injuries by a foreign body are not rare. However, in cases of lid laceration without any ocular injury, ophthalmologists do not always consider the possibility of concomitant intracranial injury (Sadiq & Thurairajan 1995). The patient usually presents to theophthalmologist only after the foreign body has been removed, especially in cases of orbital injury with a long and hard foreign body, such as a stick or a ballpoint pen. The patient may have only a tiny wound on the lid. Furthermore, he or she may not exhibit immediate neurological deficits. Although a CT scan of the head may be taken for further examination, it is not easy to ascertain the intracranial injury after the foreign body has been removed. Orbital trauma by a chopstick is not rare in East Asia (Matsuyama et al. 2001). However, the outer periorbital wound generally