Complex Anterior Skullbase Fracture Caused by a Bottle Cap: A Case Report and Review of the Literature

Jungkyu Cho; Joon Ho Kim; Sang Duk Hong

doi:10.18787/jr.2016.23.1.49

Journal List > J Rhinol > v.23(1) > 1044364

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Cho, Kim, and Hong: Complex Anterior Skullbase Fracture Caused by a Bottle Cap: A Case Report and Review of the Literature

Case Report

J Rhinol 2016;23(1):49-54.

Published online: 10 January 2016

DOI: https://doi.org/10.18787/jr.2016.23.1.49

Complex Anterior Skullbase Fracture Caused by a Bottle Cap: A Case Report and Review of the Literature

Jungkyu Cho, MD¹, Joon Ho Kim, MD², Sang Duk Hong, MD^1,

¹Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul;

²Department of Rhinology, Hana ENT Hospital, Seoul, Korea

Address for correspondence: Sang Duk Hong, MD, Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06531, Korea Tel: +82-2-3410-3579, Fax: +82-2-3410-3879, E-mail: kkam97@gmail.com

Received 22 July 2015 Revised 13 August 2015 Accepted 14 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We report a case of foreign body presence in the ethmoid sinus cavity with anterior skull base fracture and visual loss. A 42-year-old male had an uncertain history of trauma and a penetrating wound near the left medial canthus. Computed tomography imaging showed a 3.0-cm bottle cap penetrating into the anterior skull base. He underwent foreign body removal, canalicular repair, ethmoidectomy, and cerebrospinal fluid leakage repair using packing material. Six months after the initial surgery, a second-stage operation for blowout fracture repair was performed. At the 18-month postoperative follow-up from the initial surgery, the patient had no complaints except anosmia. This is a very rare case of a large, blunt, foreign body penetrating into the anterior skull base without long-term complications after successful removal and skull base repair. Simultaneous repair of cerebrospinal fluid leakage, management of canaliculi injury, and traumatic optic nerve neuropathy should be considered in such cases.

Keywords: Skull base, Bottle cap, Foreign body.

References

1). Brinson GM, Senior BA, Yarbrough WG. Endoscopic management of retained airgun projectiles in the paranasal sinuses. Otolaryngol Head Neck Surg. 2004; 130:25–30.

2). Udwadia RA, Maniar D, Acharya M. A transethmoid transorbital foreign body. J Laryngol Otol. 1994; 108:441–2.

3). Tsao YH, Kao CH, Wang HW, Chin SC, Moe KS. Transorbital penetrating injury of paranasal sinuses and anterior skull base by a plastic chair glide: management options of a foreign body in multiple anatomic compartments. Otolaryngol Head Neck Surg. 2006; 134:177–9.

4). Garces SM, Norris CW. Unusual frontal sinus foreign body. J Laryngol Otol. 1972; 86:1265–8.

5). Fallon MJ, Plante DM, Brown LW. Wooden transnasal intracranial penetration: an unusual presentation. J Emerg Med. 1992; 10:439–43.

6). Donald PJ, Gadre AK. Neuralgia-like symptoms in a patient with an airgun pellet in the ethmoid sinus: a case report. J Laryngol Otol. 1995; 109:646–9.

7). Asano T, Ohno K, Takada Y, Suzuki R, Hirakawa K, Monma S. Fractures of the floor of the anterior cranial fossa. J Trauma. 1995; 39:702–6.

8). Cetinkaya EA, Okan C, Pelin K. Transnasal, intracranial penetrating injury treated endoscopically. J Laryngol Otol. 2006; 120:325–6.

9). Dodson KM, Bridges MA, Reiter ER. Endoscopic transnasal management of intracranial foreign bodies. Arch Otolaryngol Head Neck Surg. 2004; 130:985–8.

10). Sharif S, Roberts G, Phillips J. Transnasal penetrating brain injury with a ball-pen. Br J Neurosurg. 2000; 14:159–60.

11). Thomas S, Daudia A, Jones NS. Endoscopic removal of foreign body from the anterior cranial fossa. J Laryngol Otol. 2007; 121:794–5.

12). Gray ST, Wu AW. Pathophysiology of iatrogenic and traumatic skull base injury. Adv Otorhinolaryngol. 2013; 74:12–23.

13). Friedman JA, Ebersold MJ, Quast LM. Post-traumatic cerebrospinal fluid leakage. World J Surg. 2001; 25:1062–6.

14). Emanuelli E, Bignami M, Digilio E, Fusetti S, Volo T, Castelnuovo P. Post-traumatic optic neuropathy: our surgical and medical protocol. Eur Arch Otorhinolaryngol 2014. In press.

15). Kumaran AM, Sundar G, Chye LT. Traumatic optic neuropathy: a review. Craniomaxillofac Trauma Reconstr. 2015; 8:31–41.

16). Levin LA, Joseph MP, Rizzo JF 3rd, Lessell S. Optic canal decompression in indirect optic nerve trauma. Ophthalmology. 1994; 101:566–9.

17). Mine S, Yamakami I, Yamaura A, Hanawa K, Ikejiri M, Mizota A, et al. Outcome of traumatic optic neuropathy. Comparison between surgical and nonsurgical treatment. Acta Neurochir (Wien). 1999; 141:27–30.

18). Yu-Wai-Man P, Griffiths PG. Steroids for traumatic optic neuropathy. Cochrane Database Syst Rev. 2013; 6:CD006032.

19). Beck RW, Cleary PA, Anderson MM Jr, Keltner JL, Shults WT, Kaufman DI, et al. A randomized, controlled trial of corticosteroids in the treatment of acute optic neuritis. The Optic Neuritis Study Group. N Engl J Med. 1992; 326:581–8.

Fig. 1.

A: Entry wound over the left medial canthus. B: Needle probing showing canalicular injury and medial canthal laceration. C: Sagittal computed tomography (CT) scan showing a bottle cap in the anterior ethmoid sinus with anterior skull base disruption. D: Coronal CT scan showing bilateral medial orbital wall fracture with displacement of the crista galli and cribriform plate (white arrow).

Fig. 2.

A: Postoperative 18-month facial photo showing a well healed wound without orbital displacement. B: Endoscopic exam showing repaired anterior skull base without CSF leakage (white arrow). Endoscopic follow-up of the skull base was possible at the outpatient clinic because complete ethmoidectomy was performed simultaneously at the initial surgery. C: Sagittal computed tomography scan showing a well delineated anterior skull base without herniation (white arrow). D: Coronal CT scan showing the orbit wall reconstructed with medpor implant material (white arrow).

Table 1.

Published cases of anterior skull base injuries with ethmoid and intradural foreign bodies

Number	Year	Author	Sex/ Age	Size (cm)	Shape	Type of foreign body	Entry point	Route of removal	CSF rhinorrhea			Visual impairment	Postoperative complications
Number	Year	Author	Sex/ Age	Size (cm)	Shape	Type of foreign body	Entry point	Route of removal	Preoperative	Intraoperative	Repair method	Visual impairment	Postoperative complications
1	1992	Fallon et al.	F/2	7.0	Sharp	Wooden stick	Endonasal	Craniotomy	None	Yes	Packing	None	None
2	1995	Asano et al.	NS	NS	Sharp	Metallic fragment	Transorbital	External	None	Yes	NS	Permanent^†	Visual loss
3	2000	Sharif et al.	M/44	14	Sharp	Ballpoint pen	Endonasal	Craniotomy	Yes	Yes	NS	None	None
4	2004	Brinson et al.	M/15	0.5	Round	Airgun projectile	Endonasal	Endonasal	None	Yes	Septal mucosal graft	None	None
5	2004	Dodson et al.	M/34	6.0	Sharp	Metallic pen	Endonasal	Endonasal	None	Yes	Bone and mucosal graft	None	None
6	2006	Tsao et al.	M/45	2.5	Blunt	Plastic chair glide	Transorbital	Combined^*	None	None^**	Not performed	Temporary	CSF leakage
7	2006	Cetinkaya et al.	F/4	25	Sharp	Pencil	Endonasal	Endonasal	None	Yes	Packing, lumbar drain	None	None
8	2007	Thomas et al.	M/41	0.3	Round	Airgun projectile	Endonasal	Endonasal	None	Yes	Turbinate mucosal graft	None	None

^* : p＜ Combined endonasal endoscopic and external approach

^** : p＜ Delayed CSF leakage was observed 3 days after the operation

^† : Permanent visual impairment due to direct optic canal injury. CSF: cerebrospinal fluid, NS: not stated

TOOLS

Similar articles