Clinical communication| Volume 10, ISSUE 4, P439-443, July 1992

Wooden transnasal intracranial penetration: An unusual presentation

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      A Math Eq presented to the emergency department with a wooden stick lodged firmly in her right nares. No nasal discharge or neurological abnormalities were noted at presentation. After plain radiographs failed to demonstrate any evidence of a foreign body, computed tomography (CT scan) was obtained that revealed a hypodense region in the right frontal lobe corresponding to the projected tract of the branch. The patient underwent a right frontal craniotomy with debridement of her contused right frontal lobe. She was discharged 8 days postoperatively without evidence of neurologic sequelae. This case illustrates an unusual presentation of intracranial penetration, with only six similar cases found in the literature. It also highlights the need for the emergency physician to be concerned about intracranial penetration when treating intranasal foreign bodies, particularly those of the nonmetallic type. The literature is reviewed regarding transnasal intracranial penetration by wooden foreign bodies.


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        • Doron Y.
        • Gruszkiewicz J.
        • Peyser E.
        Penetrating craniocerebral injuries due to unusual foreign bodies.
        Neurosurg Rev. 1982; 5: 35-40
        • Davis E.
        Two specimens: abscess in frontal lobe of brain: sinus suppuration.
        in: 3rd ed. Proc R Soc Med.27. 1934: 1285-1288
        • Healy J.
        Computed tomography of a cranial wooden foreign body..
        J Comput Assist Tomogr. 1980; 4: 555-556
        • Key S.
        • McCrummen T.
        Foreign body in the brain.
        JAMA. 1932; 99: 152
        • Stadler H.
        • Manders K.
        • Marks J.
        • Bonsett C.
        Recurrent brain abscess due to unusual foreign body — a case report.
        J Indiana St Med Assoc. 1973; 65: 799-802
        • deTribolet N.
        • Guignard G.
        • Zander E.
        Brain abscess after transnasal intracranial penetration of a paint-brush.
        Surg Neurol. 1975; 11: 187-189
        • Yamamoto I.
        • Yamada S.
        • Sato O.
        Unusual craniocerebral penetrating injury by a chopstick.
        Surg Neurol. 1985; 23: 396-398
        • Miller C.F.
        • Brodkey J.S.
        • Colombi B.J.
        The danger of intracranial wood.
        Surg Neurol. 1977; 7: 95-103
        • Hansen J.
        • Gudeman S.
        • Holgate R.
        • Saunders R.
        Penetrating intracranial wood wounds: clinical limitations of computerized tomography.
        J Neurosurg. 1988; 68: 752-756
        • Kuhns L.
        • Borlaza G.
        • Seigel R.
        • Paramagul C.
        • Berger P.
        An in vitro comparison of computed tomography, xeroradiography, and radiography in the detection of soft-tissue foreign bodies.
        Radiology. 1979; 132: 218-219
        • Jooma R.
        • Bradsha J.
        • Coakham H.
        Computed tomography in penetrating cranial injury by a wooden foreign body.
        Surg Neurol. 1984; 21: 236-238
        • Kaiser M.
        • Rodesch G.
        • Capesius P.
        CT in a case of intracranial penetration of a pencil.
        Neuroradiology. 1983; 24: 229-231
        • Bursick D.
        • Selker R.
        Intracranial pencil injuries.
        Surg Neurol. 1981; 16: 427-431
        • Bard L.
        • Jarret W.
        Intracranial complications of penetrating orbital injuries.
        Arch Ophthalmol. 1964; 71: 332-343
        • Birch-Hirschfield A.
        Puncture wounds of the orbit.
        in: 3rd ed. Handbuch der gesamtem Augenheilkunde. vol 9. Springer, Berlin1930: 461-471
        • Kjer P.
        Orbital and transorbital stab wounds.
        Arch Ophthalmol. 1954; 51: 811-821
        • American College of Emergency Physicians
        Tetanus immunization recommendations for persons less than seven years old.
        Ann Emerg Med. 1987; 16: 1181-1183
        • American College of Emergency Physicians
        Tetanus immunization recommendations for persons seven years of age or older.
        Ann Emerg Med. 1986; 15: 1111-1112
        • Sanford J.
        3rd ed. Guide to antimicrobial therapy 1990. Antimicrobial Therapy Inc, Bethesda, Maryland1991: 4