Optik sinire uzanım gösteren tahta bir yabancı cismin transkonjonktival medial anterior orbitotomi ile çıkarılması: Bir olgu sunumu

Öz

İntraorbital yabancı cisimler kimyasal içeriklerine göre organik ve inorganik olarak sınıflandırılabilirler. Tahta inorganik yapıda ve intraorbital yabancı cisim yaralanmalarının nadir fakat şiddetli bir formudur. İntraorbital tahta yabancı cisim yaralanmalarının değerlendirilmesi ve yönetimi oldukça zordur ve ciddi orbital komplikasyonlara yol açabilir. Bu yazıda, otuz-üç yaşındaki erkek hastanın sol orbitasına tahta bir yabancı cisim ile olan penetran yaralanmasını sunuyoruz. Bilgisayarlı tomografi ile sol supraorbital bölgeden intrakonal bölgeye uzanım gösteren doğrusal bir yabancı cisim görüntülendi. Yabancı cismin ucu optik sinire yapısal bütünlüğünü bozmadan temas etmekteydi. Hastaya transkonjonktival medial anterior orbitotomi uygulandı ve tahta yabancı cisim intrakonal bölgede optik sinire çok yakın lokalize olarak bulundu. Kontrollü traksiyonla 7 cm’lik bir tahta parçası tamamen çıkartıldı. Postoperatif dönem normal oftalmik muayeneyle sorunsuzdu. Transkonjonktival medial anterior orbitotomi intrakonal bölgelerdeki tahta yabancı cisimlerin çıkartılması için kullanışlı ve etkili bir yöntemdir.

Anahtar Kelimeler

• tahta yabancı cisim,intrakonal,intraorbital,optik sinir,orbitotomi

Transconjunctival medial anterior orbitotomy for the removal of a wooden intraorbital foreign body extending to the optic nerve: A case report

Abstract

Intraorbital foreign bodies can be classified into organic or inorganic according to their chemical composition. Wooden is inorganic in nature and is a rare, but serious form of intraorbital foreign body injuries. Evaluation and management of intraorbital wooden foreign bodies are highly challenging and can lead to severe orbital complications. In this paper, we report a case of a 33-year old man who presented with a penetrating wooden foreign body injury to the left orbit. Computed tomography revealed a linear shaped foreign body extending from left supraorbital ridge to the intraconal area. The tip of the foreign body was touching to the optic nerve without disrupting its integrity. The patient underwent transconjunctival medial anterior orbitotomy and the wooden foreign body was found to be located close proximity to the optic nerve in intraconal space. A 7cm wooden stick was removed completely with controlled traction. Postoperative recovery was uneventful with normal ophthalmic examination. Transconjunctival medial anterior orbitotomy is a useful and effective method for the removal of intraorbital wooden foreign bodies located in intraconal space.

Keywords

• wooden foreign body,intraconal,intraorbital,optic nerve,, orbitotomy

References

1. 1. Tas S, Top H. Intraorbital wooden foreign body: clinical analysis of 32 cases, a 10-year experience. Ulus Travma Acil Cerrahi Derg. 2014;20:51-5.
2. 2. Chen J, Shen T, Wu Y, Yan J. Clinical characeteristics and surgical treatment of intraorbital foreign bodies in a tertiary eye center. J Craniofac Surg. 2015;26:e486-9.
3. 3. Purgason PA, Hornblass A. Complications of surgery for orbital tumors. Ophthal Plast Reconstr Surg. 1992;8:88-93.
4. 4. Di Gaeta A, Giurazza F, Capobianco E, Diano A, Muto M. Intraorbital wooden foreign body detected by computed tomography and magnetic resonance imaging. Neuroradiol J. 2017;30:88-91.
5. 5. John SS, Rehman TA, John D, Raju RS. Missed diagnosis of a wooden intra-orbital foreign body Indian J Ophthalmol. 2008;56:322-4.
6. 6. Dunn IF, Kim DH, Rubin PA, Blinder R, Gates J, Golby AJ. Orbitocranial wooden foreign body: a pre-, intra-, and postoperative chronicle: case report. Neurosurgery. 2009;65:E383-4.
7. 7. Siedlecki AN, Tsui E, Deng J, Miller DM. Long-term retention of an intraorbital metallic foreign body adjacent to the optic nerve. Case Rep Ophthalmol Med. 2016;2016:3918592.
8. 8. Shelsta HN, Bilyk JR, Rubin PA, Penne RB, Carrasco JR. Wooden intraorbital foreign body injuries: clinical characteristics and outcomes of 23 patients. Ophthal Plast Reconstr Surg. 2010;26:238-44.

9. 9. Yoshii M, Enoki T, Mizukawa A, Okisaka S. Intraorbital wooden foreign body. Acta Ophthalmol Scand. 2004;82:492-3.
10. 10. Teh D, Mohamad NF, Lim E, Zulkiflee AB, Narayanan P, Kamalden TA. Endoscopic transnasal removal of an intraconal foreign body using an image-guided surgical system. Comput Assist Surg. 2016;21:25-8.
11. 11. Koo Ng NK, Jaberoo MC, Pulido M, Olver JM, Saleh HA. Image guidance removal of a foreign body in the orbital apex. Orbit. 2009;28:404-7.
12. 12. Nishio Y, Hayashi N, Hamada H, Hirashima Y, Endo S. A case of delayed brain abscess due to a retained intracranial wooden foreign body: a case report and review of the last 20 years. Acta Neurochir. 2004;146:847-50. .