PMC9990803_01
Photograph of the patient at the presentation, right oblique view, shows marked swelling and redness centered in the right upper eyelid, with the edge of broken shoji frame exposed superficially in the lateral part of the eyelid, as indicated with asterisk.
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F1
In addition, the edge of the broken shoji frame was superficially exposed in the lateral part of the eyelid [Figure 1].
Non-contrast axial (a), coronal at the equator level of the bulb (b) and orbital apex (c), and sagittal (d) computed tomography, 3 mm in slice thickness, show a homogeneously hypodense, linear structure located in the upper lateral sector of the orbit, partially protruding into the middle fossa. Contrast-enhanced axial computed tomography revealed the ophthalmic artery (OA) and superior ophthalmic vein (SOV) to be intact (e). ACP : Anterior clinoid process, LRM : Lateral rectus muscle, SRM: Superior rectus muscle, Arrow: Fracture in the sphenoid bone, Arrowheads: Displaced inner table of the sphenoid bone, Asterisk: Broken shoji frame.
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F2
Contrast CT showed that the ophthalmic artery and superior ophthalmic vein were intact [Figure 2].
Intraoperative photos present step-by-step procedures of extraction. (a) Intradural view: site of the proximal edge of broken shoji frame is identified as a localized inner protrusion of the MF dura (arrowhead). (b) Extradural view: proximal edge of the shoji frame (arrowhead) is marked with pyoktanin blue. (c) Extradural view: proximal edge of the shoji frame (arrowhead) is being pushed out from the cranial cavity using a Penfield dissector (double asterisk). SV : Sylvian vein, MF: Middle fossa.
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F3
Initially, the site of the localized inner protrusion of the middle fossa (MF) dura, caused by the proximal edge of the broken shoji frame, was identified from the intradural side [Figure 3a]. Next, the proximal edge of the broken shoji frame was secured from the extradural side [Figure 3b]. The edge was then pushed out from the cranial cavity using a Penfield dissector, while simultaneously pulling the distal edge through the stab wound in the upper eyelid [Figure 3c].
Photograph of shoji frame extracted in two pieces. The flat frame measures 1 cm in width and 5 cm in length. The surfaces of the frame are smooth. Arrowhead: Proximal edge of the shoji frame; Asterisk: superficially exposed, distal part of the shoji frame.
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F4
The frame was flat, measured 1 cm in width and 5 cm in length, and had smooth surfaces [Figure 4].
Photographs of frontal (a) and right lateral (b) views of patients, captured 2 weeks after surgery, show resolution of marked swelling and redness found in the right upper eyelid, accompanied by horizontal skin depression (arrow).
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F5
However, restriction of ocular movement on the lateralward gaze persisted, accompanied by horizontal skin depression in the affected upper eyelid [Figure 5].