Injury to the Temporal Lobe via Medial Transorbital Entry of a Toothbrush
14. Dezember 2012
03. Januar 2013
29. Mai 2013 (online)
Objectives Intracranial penetration by foreign bodies entering via the orbit represent an unusual form of traumatic brain injury. Nevertheless, much is at stake with high risk for cranial nerve and neurovascular injury. We present a case where the bristled end of a toothbrush entered the brain as a projectile via the superior orbital fissure and discuss considerations for surgical management.
Setting A 35-year-old woman suffered a periorbital injury after her husband threw an electric toothbrush at a wall and the head of the toothbrush became a missile that projected through her superior orbital fissure and into her right temporal lobe. She complained of headache and incomplete vision loss in the affected eye.
Intervention After obtaining a cerebrovascular angiogram, we proceeded with emergent orbital decompression and anterograde extraction of the foreign body via a modified frontotemporal orbitozygomatic approach with drilling of the skull base allowing for en bloc removal of the toothbrush.
Conclusions The patient recovered well with improvement in her vision and partial third and sixth nerve palsies. This report illustrates a unique mechanism of injury with a novel intracranial foreign body. We review the neurosurgeon's need for prompt management with an approach customized to the structure of the offending object, the damaged elements, and the surrounding cranial nerves and vascular anatomy.
- 1 Bard LA, Jarrett WH. Intracranial complications of penetrating orbital injuries. Arch Ophthalmol 1964; 71: 332-343
- 2 Turbin RE, Maxwell DN, Langer PD , et al. Patterns of transorbital intracranial injury: a review and comparison of occult and non-occult cases. Surv Ophthalmol 2006; 51 (5) 449-460
- 3 Dunn IF, Kim DH, Rubin PA , et al. Orbitocranial wooden foreign body: a pre-, intra-, and postoperative chronicle: case report. Neurosurgery 2009; 65 (2) E383-E384
- 4 Schreckinger M, Orringer D, Thompson BG, La Marca F, Sagher O. Transorbital penetrating injury: case series, review of the literature, and proposed management algorithm. J Neurosurg 2011; 114 (1) 53-61
- 5 Lunetta P, Ohberg A, Sajantila A. Suicide by intracerebellar ballpoint pen. Am J Forensic Med Pathol 2002; 23 (4) 334-337
- 6 Large M, Babidge N, Nielssen O. Intracranial self-stabbing. Am J Forensic Med Pathol 2012; 33 (1) 13-18
- 7 Strub WM, Weiss KL. Self-inflicted transorbital and intracranial injury from eyeglasses. Emerg Radiol 2003; 10 (2) 109-111
- 8 Lemole GM, Henn JS, Zabramski JM, Spetzler RF. Modifications to the orbitozygomatic approach. Technical note. J Neurosurg 2003; 99 (5) 924-930
- 9 Gennarelli TA, Champion HR, Sacco WJ, Copes WS, Alves WM. Mortality of patients with head injury and extracranial injury treated in trauma centers. J Trauma 1989; 29 (9) 1193-1201
- 10 Koutroumanidis M, Pearce R, Sadoh DR, Panayiotopoulos CP. Tooth brushing-induced seizures: a case report. Epilepsia 2001; 42 (5) 686-688
- 11 Navarro V, Adam C, Petitmengin C, Baulac M. Toothbrush-thinking seizures. Epilepsia 2006; 47 (11) 1971-1973
- 12 Lasky JB, Epley KD, Karesh JW. Household objects as a cause of self-inflicted orbital apex syndrome. J Trauma 1997; 42 (3) 555-558
- 13 Udwadia RA, Maniar D, Acharya M. A transethmoid transorbital foreign body. J Laryngol Otol 1994; 108 (5) 441-442
- 14 Greene KA, Dickman CA, Smith KA, Kinder EJ, Zabramski JM. Self-inflicted orbital and intracranial injury with a retained foreign body, associated with psychotic depression: case report and review. Surg Neurol 1993; 40 (6) 499-503
- 15 Matsumoto S, Hasuo K, Mizushima A , et al. Intracranial penetrating injuries via the optic canal. AJNR Am J Neuroradiol 1998; 19 (6) 1163-1165
- 16 Mitilian D, Charon B, Brunelle F, Di Rocco F. Removal of a chopstick out of the cavernous sinus, pons, and cerebellar vermis through the superior orbital fissure. Acta Neurochir (Wien) 2009; 151 (10) 1295-1297
- 17 Cato-Addison WB, Demetriades AK, Saker R, Verity DH, Marsh H. Near lethal art–transorbital brain injury. Orbit 2007; 26 (4) 279-281
- 18 Kitakami A, Kirikae M, Kuroda K, Ogawa A. Transorbital-transpetrosal penetrating cerebellar injury–case report. Neurol Med Chir (Tokyo) 1999; 39 (2) 150-152
- 19 MacEwen CJ, Fullarton G. A penetrating orbitocranial stab wound. Br J Ophthalmol 1986; 70 (2) 147-149
- 20 O'Neill OR, Gilliland G, Delashaw JB, Purtzer TJ. Transorbital penetrating head injury with a hunting arrow: case report. Surg Neurol 1994; 42 (6) 494-497
- 21 Chen CT, Chen YR. Traumatic superior orbital fissure syndrome: current management. Craniomaxillofac Trauma Reconstr 2010; 3 (1) 9-16
- 22 Miller CF, Brodkey JS, Colombi BJ. The danger of intracranial wood. Surg Neurol 1977; 7 (2) 95-103
- 23 Nelson Filho P, Macari S, Faria G, Assed S, Ito IY. Microbial contamination of toothbrushes and their decontamination. Pediatr Dent 2000; 22 (5) 381-384
- 24 Taji SS, Rogers AH. ADRF Trebitsch Scholarship. The microbial contamination of toothbrushes. A pilot study. Aust Dent J 1998; 43 (2) 128-130