PMC6258364_01
Showing the preoperative presentation of the patient with the foreign body in situ. (a) frontal view of the patient with unequal eye level. (b, c) Paranasal sinuses and lateral skull views respectively. (d, e, f) Axial, coronal and 3D computed tomography cuts respectively.
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Upon inspection, it was noted that the left globe was displaced superiorly with increased scleral show (Fig. 1a). Plain radiography (Paranasal sinuses view (P.N.S) and lateral skull view) revealed a radiopaque foreign body (FB) lodged inside the orbital floor and directed downward & posteriorly (Fig. 1b and c). The foreign body was found penetrating the facial skeleton at the level of the orbital floor and transgressed the maxillary antrum and its tip reaching the pterygoid plates of maxilla (Fig. 1d-f).
Showing the immediate postoperative results (a) the extracted knife blade (the foreign body) (b, c) posteroanterior and lateral skull views respectively showing the retained tip of the foreign body. (d) postoperative 3D computed tomography showing the resultant defect in the inferior orbital rim.
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A wire-twister was used to firmly grasp the foreign body which was retrieved without any significant bleeding and was found to be a stainless steel knife blade (Fig. 2a). The patient was discharged the same day of the operation and was regularly monitored in the first two weeks postoperatively (Fig. 2b-d).
Showing clinical and radiographic results of the follow up period (a) Frontal view of the patient at 1 year postoperative with equal eye level. (b) 3D computed tomography at 2 years postoperative showing bone healing at the previous defect in the inferior orbital rim. (c) axial CT cut of the retained foreign body at 2 years of postoperative follow up.
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At 1 year of postoperative follow up, clinical examination showed normal symmetrical eye position and no ectropion (Fig. 3a) as well as improvement in the neurosensory deficit. At 2 years of postoperative follow up, radiographic examination showed bone healing of the previous defect at the orbital rim (Fig. 3b). It also demonstrated that the impacted portion of the foreign body has remained lodged in the exact same position (Fig. 3c).