CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2018; 07(02): 142-146
DOI: 10.1055/s-0037-1599790
Case Report
Thieme Medical and Scientific Publishers Private Ltd.

Massive Penetrating Craniofacial Trauma due to Polyvinyl Chloride Pipe

Somashekhar Srinivas
1   Department of Burns and Plastic Surgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
,
Amit Agrawal
2   Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
,
Yashawant Sandeep
2   Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
,
Ninad Nareschandra Shrikhande
2   Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
› Author Affiliations
Further Information

Publication History

Received: 27 August 2016

accepted after revision: 23 January 2017

Publication Date:
18 April 2017 (online)

Abstract

Penetrating craniofacial trauma can lead to massive injury to the facial tissue and craniofacial skeleton with retained bone as well as foreign body. We present a case of 45-year-old man who sustained massive penetrating craniofacial injuries due to polyvinyl chloride (PVC) pipe. CT scan with bone window of the brain and craniofacial region showed in driven fragment of PVC pipe into the nasal cavity with multiple fractures and soft tissue swelling. CT brain showed compound and comminuted depressed fracture of the right frontal bone with underlying contusion of the brain and specks of pneumocephalus. However, detailed examination of the CT scan showed that there was no breach in the anterior cranial fossa and that both the injuries were caused by separate pipe fragments. The wound was debrided; all loose bone fragments, necrotic brain matter, and broken pipe fragments were removed. The patient recovered well after surgical procedure. The approach is aimed to protect the airway, maintain vital parameters followed by remove all the foreign body and necrotic tissue, and restore the functioning and aesthetics. A careful evaluation of the CT scan is mandatory to rule out breach in the skull base, and if the skull base is intact, a limited craniotomy will save the time and associated morbidity.

 
  • References

  • 1 Dubhashi SP, Choudhary K. Penetrating facial injury. Indian J Surg 2014; 76 (03) 237-238
  • 2 Agrawal A, Mishra V, Jain H, Reddy VU. Management of craniofacial injuries: a primer for residents. Romanian Neurosurgery 2014; 21: 341-347
  • 3 Erisen L, Basut O, Coskun H, Hizalan I. An unusual penetrating facial injury due to a fishing-line sinker. J Oral Maxillofac Surg 2001; 59 (08) 945-947
  • 4 Al Hashmi A, Cheng A, Nikolarakos D, Goss A. Penetrating injuries to the orbit despite safety equipment. Br J Oral Maxillofac Surg 2009; 47 (01) 71-72
  • 5 Kwon B, Chang HW, Kim SJ, Sohn I, Choi TH. Penetrating facial injury. Emerg Med J 2014; 31 (09) 774
  • 6 Patel NN, Wang SC, Marentette L. Penetrating injury of the cheek requiring skull base exploration. J Laryngol Otol 2002; 116 (07) 548-550
  • 7 Polini F, Robiony M, Toro C, Costa F, Sembronio S, Politi M. Penetrating injury of the facial skeleton through the orbit, by a massive metallic shotgun block: a case report. Br J Oral Maxillofac Surg 2007; 45 (07) 586-587
  • 8 Shadid O, Simpson M, Sizer J. Penetrating injury of the maxillofacial region with an arrow: an unsuccessful attempt of suicide. Br J Oral Maxillofac Surg 2008; 46 (03) 244-246
  • 9 Strong B, Coady M. Penetrating facial injury with an “Airsoft” pellet: a case report. Br J Oral Maxillofac Surg 2014; 52 (09) e129-e131
  • 10 Agrawal ATrans-orbital penetrating head injury. Indian J Neurotrauma. 2014
  • 11 Agrawal A, Pratap A, Agrawal CS, Kumar A, Rupakheti S. Transorbital orbitocranial penetrating injury due to bicycle brake handle in a child. Pediatr Neurosurg 2007; 43 (06) 498-500
  • 12 Agrawal A, Reddy VU, Kumar SS, Hegde KV, Rao GM. Transorbital orbitocranial penetrating injury with an iron rod. Craniomaxillofac Trauma Reconstr 2016; 9 (02) 145-148
  • 13 Bakay L, Glasauer FE, Grand W. Unusual intracranial foreign bodies. Report of five cases. Acta Neurochir (Wien) 1977; 39 (03) (04) 219-231
  • 14 Herring CJ, Lumsden AB, Tindall SC. Transcranial stab wounds: a report of three cases and suggestions for management. Neurosurgery 1988; 23 (05) 658-662
  • 15 Pascual JM, Navas M, Carrasco R. Penetrating ballistic-like frontal brain injury caused by a metallic rod. Acta Neurochir (Wien) 2009; 151 (06) 689-691
  • 16 Salar G, Costella GB, Mottaran R, Mattana M, Gazzola L, Munari M. Multiple craniocerebral injuries from penetrating nails. Case illustration. J Neurosurg 2004; 100 (05) 963
  • 17 Karim T, Topno M. An unusual case of penetrating head injury in a child. J Emerg Trauma Shock 2010; 3 (02) 197-198
  • 18 Atabaki SM. Pediatric head injury. Pediatrics in Review. Am Acad Pediatr 2007; 28: 215-224
  • 19 Domingo Z, Peter JC, de Villiers JC. Low-velocity penetrating craniocerebral injury in childhood. Pediatr Neurosurg 1994; 21 (01) 45-49
  • 20 Kataria R, Singh D, Chopra S, Sinha VD. Low velocity penetrating head injury with impacted foreign bodies in situ. Asian J Neurosurg 2011; 6 (01) 39-44
  • 21 Carr MM, Freiberg A, Martin RD. Facial fractures. Can Fam Physician 1994; 40: 519-524 527–528
  • 22 Blissitt PA. Care of the critically ill patient with penetrating head injury. Crit Care Nurs Clin North Am 2006; 18 (03) 321-332
  • 23 Shah MU, Sridhara SK, Wolf JS, Ambro BT. Retained crossbow bolt after penetrating facial trauma. Ear Nose Throat J 2016; 95 (01) E1-E4
  • 24 Bacelar MT, Rao VM. Facial and other head and neck trauma: imaging patterns and their significance. Appl Radiol 2002; 31: 20-27
  • 25 Hollier Jr LH, Sharabi SE, Koshy JC, Stal S. Facial trauma: general principles of management. J Craniofac Surg 2010; 21 (04) 1051-1053
  • 26 Reuben AD, Watt-Smith SR, Dobson D, Golding SJ. A comparative study of evaluation of radiographs, CT and 3D reformatted CT in facial trauma: what is the role of 3D?. Br J Radiol 2005; 78 927 198-201
  • 27 Sidebottom AJ, Sissons G. Radiographic screening for midfacial fracture in A&E. Br J Radiol 1999; 72 858 523-524
  • 28 Kanagarajan A, Sgouros S. Unusual penetrating cranio-cerebral injuries in children from mains plugs. Childs Nerv Syst 2007; 23 (10) 1181-1183
  • 29 Pereira KD, Wang BS, Webb BD. Impalement injuries of the pediatric craniofacial skeleton with retained foreign bodies. Arch Otolaryngol Head Neck Surg 2005; 131 (02) 158-162
  • 30 Neuroimaging in the management of penetrating brain injury. J Trauma 2001; 51 (02) Suppl S7-S11
  • 31 Aarabi B. Comparative study of bacteriological contamination between primary and secondary exploration of missile head wounds. Neurosurgery 1987; 20 (04) 610-616
  • 32 Nagib MG, Rockswold GL, Sherman RS, Lagaard MW. Civilian gunshot wounds to the brain: prognosis and management. Neurosurgery 1986; 18 (05) 533-537
  • 33 Chen AY, Stewart MG, Raup G. Penetrating injuries of the face. Otolaryngol Head Neck Surg 1996; 115 (05) 464-470
  • 34 Kazim SF, Shamim MS, Tahir MZ, Enam SA, Waheed S. Management of penetrating brain injury. J Emerg Trauma Shock 2011; 4 (03) 395-402
  • 35 Taylor AG, Peter JC. Patients with retained transcranial knife blades: a high-risk group. J Neurosurg 1997; 87 (04) 512-515
  • 36 Iordache A, Kaya J, Alliez J, Alliez B. A rare case of severe craniocerebral trauma with penetrating head injury. Romanian Neurosurg 2011; 18: 77-81
  • 37 Nason RW, Assuras GN, Gray PR, Lipschitz J, Burns CM. Penetrating neck injuries: analysis of experience from a Canadian trauma centre. Can J Surg 2001; 44 (02) 122-126
  • 38 Agrawal R, Timilsina DS, Reddy NS, Ganguly SN, Tayal A. Penetrating foreign body neck: a case report. Kathmandu Univ Med J (KUMJ) 2007; 5 (03) 414-416
  • 39 Mohan S, Varghese G, Kumar S, Subramanian DP. Penetrating facial injury by a wooden log. Natl J Maxillofac Surg 2014; 5 (02) 228-231
  • 40 Surgical management of penetrating brain injury. J Trauma 2001; 51 (02) Suppl S16-S25
  • 41 Hubschmann O, Shapiro K, Baden M, Shulman K. Craniocerebral gunshot injuries in civilian practice—prognostic criteria and surgical management: experience with 82 cases. J Trauma 1979; 19 (01) 6-12
  • 42 Gönül E, Baysefer A, Kahraman S. et al. Causes of infections and management results in penetrating craniocerebral injuries. Neurosurg Rev 1997; 20 (03) 177-181
  • 43 Aarabi B, Taghipour M, Alibaii E, Kamgarpour A. Central nervous system infections after military missile head wounds. Neurosurgery 1998; 42 (03) 500-507 discussion 507–509
  • 44 Esposito DP, Walker JB. Contemporary management of penetrating brain injury. Neurosurg Q 2009; 19: 249-254
  • 45 Haworth CS, de Villiers JC. Stab wounds to the temporal fossa. Neurosurgery 1988; 23 (04) 431-435
  • 46 Hagan RE. Early complications following penetrating wounds of the brain. J Neurosurg 1971; 34 (02) Pt 1 132-141
  • 47 Kothari K, Singh AK, Das S. Penetrating skull injury with six inch fence rod. Natl J Maxillofac Surg 2012; 3 (02) 207-210