PMC6558516_01
Radiograph of the skull showed faint pencil shadow over the left nasal cavity projecting towards the anterior skull base.
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F1
Radiograph of the skull (Figure 1(Fig. 1)) showed faint pencil shadow over the left nasal cavity projecting towards the anterior skull base.
Endoscopic view of the left nasal cavity showed the pencil was impacted in the left nostril and nasal septum.
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F2
Intraoperatively, the pencil was impacted firmly in the left nostril and nasal septum (Figure 2(Fig. 2)).
(A) The embedded pencil measured 8 cm in length and 1 cm in diameter. (B) Pulsatile clear fluid from the skull base with positive 'Halo' sign on filter paper further confirmed the skull base fracture with CSF leak.
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F3
There was a posterior nasal septal perforation following the removal of the pencil. The embedded pencil measured 8 cm in length and 1 cm in diameter (Figure 3A(Fig. 3)). Pulsatile clear fluid from the skull base was demonstrated immediately after removal of the pencil further which confirmed the skull base fracture with CSF leak (Figure 3B(Fig. 3)).
Three-dimensional (3D) images reconstructed from the fine cut CT scan of the brain, skull base and paranasal sinuses showed right cribriform plate fracture.
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F4
Computed Tomography (CT) scan of the brain, skull base and paranasal sinuses post-operatively showed right cribriform plate fracture with small pneumocranium (Figure 4(Fig. 4)).