Transorbital Intracranial Injury by a Chopstick

A 5-year-old girl tripped while carrying a bowl of rice and plastic chopsticks. One of the plastic chopsticks penetrated the medial aspect of the right upper eyelid. In the emergency room, she was fully conscious and without any evident neurological damage. From a computed tomography (CT) study ( ► Fig. 1A and B ) and three-dimensional reconstruction ( ► Fig. 1C ), the chopstick was found to be passing through the right superior orbital fi ssure into the cranium. No hematoma was found and an angiogram showed no vascular injury. Under general anesthesia, the chopstick was withdrawn without dif fi culty in one piece ( ► Fig. 1D ) and the patient remained well without any complications. Immediate postoperative CT scan showed no evidence of neural damage or intracranial hemorrhage ( ► Fig. 1E and F ). Postoperative prophylactic antibiotics were administered to prevent infections. 1 – 4 Pre-and postoperative ophthalmological examination revealed normal visual acuity and intact ocular movements. The patient was discharged home 5 days after the operation. At a 3-month follow-up, there were no neurological/ ophthalmological de fi cits or intracranial infections. Among all head injuries, penetrating transorbital intracranial injury accounts for a small percentage. 1 – 4 Additionally, such injuries can result in ophthalmoplegia, blindness, brainstem damage, and intracerebral hemorrhage. 1 – 4 The management of these types of injuries is complex and the delay in treatment can result in a poor prognosis. 1,2,4