Tooth in Intracranial Compartment after Traumatic Brain Injury

Abstract

A 25-year-old patient was admitted to the emergency room presenting headaches after a traumatic brain injury (TBI) 30 days before, when he collided frontally with another driver. After a skull radiography, the presence of a foreign body was observed in the frontal sinus. A cranial computed tomography (CT) scan found that it was a tooth. The patient underwent surgical treatment for the removal of the tooth. Traumatic brain injury caused by non-missile penetrating objects is unusual, and has been described in case reports in the literature. To the best of our knowledge, no similar reports can be found in the literature.

 

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Resumo

Paciente com 25 anos de idade trazido à sala de emergência com quadro de cefaleia frontal , que não melhorava com uso de analgésicos. Apresentava história prévia de trauma de crânio (TCE) 30 dias antes, quando ele colidiu frontalmente com outro motorista. Após radiografia crânio, a presença de um corpo estranho foi observada no seio frontal. A tomografia computadorizada de crânio evidenciou a presença de um dente. O paciente foi submetido a tratamento cirúrgico para a remoção do dente. A evolução foi satisfatória, o paciente apresentava-se assintomática na alta hospitalar.

TCE penetrantes são incomuns e são descritos na literatura na maioria das vezes como relatos de casos. Para o nosso conhecimento, não há relatos semelhantes em outras séries sobre o assunto.

 

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Keywords

traumatic brain injury - tooth - surgery

Palavras-chave

traumatismo cranioencefálico - dente - cirurgia

Case Report

A 25-year-old patient was admitted to the emergency room presenting frontal headaches, without improvement, despite the use of pain killers. The patient had suffered a traumatic brain injury (TBI) 30 days before, when he collided frontally with another driver. After a skull radiography, the presence of a foreign body was observed in the frontal sinus. A cranial computed tomography (CT) scan found that it was a tooth ([Fig. 1]). The patient underwent surgical treatment ([Fig. 2]) for the removal of the tooth. His evolution was satisfactory, and the patient was asymptomatic upon discharge.

Fig. 1 Pre-operative images. (A, B): radiograph (AP and lateral view respectively) showing the presence of the tooth in the frontal sinus; (C): sinking present in the left frontal sinus; (D-F): axial CT scans (bone window) showing the presence of the tooth within the left frontal sinus.

Fig. 2 Operative findings. (A-C): approach by eyebrow (step by step) to remove the tooth; (D): tooth after withdrawal.

Traumatic brain injury caused by non-missile penetrating objects is unusual, and has been described in case reports in the literature,[1] and in some literature reviews that corroborate our management.[2] The most likely justification for this trauma would be the fact that the patient was not wearing a helmet during the frontal collision, and unfortunately the other driver's tooth pierced his frontal sinus. To the best of our knowledge, no similar reports can be found in the literature.

 

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No conflict of interest has been declared by the author(s).

• References

• 1 Alafaci C, Caruso G, Caffo M. , et al. Penetrating head injury by a stone: case report and review of the literature. Clin Neurol Neurosurg 2010; 112 (09) 813-816
• 2 de Holanda LF, Pereira BJ, Holanda RR. , et al. Neurosurgical Management of Nonmissile Penetrating Cranial Lesions. World Neurosurg 2016; 90: 420-429

Address for correspondence

Benedito Jamilson Araújo Pereira, MD

Rua Martiniano de Carvalho, 669

Edifício Paulista Paradise Life, Apto 1105, São Paulo, SP

Brazil   

Email: [e-mail]