J Rhinol.  2016 May;23(1):49-54. 10.18787/jr.2016.23.1.49.

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

• Cho J
• Kim JH
• Hong SD

• KMID: 2165155
• DOI: http://doi.org/10.18787/jr.2016.23.1.49

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 blow-out 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.

Keyword

Skull base; Bottle cap; Foreign body

MeSH Terms

Adult
Cerebrospinal Fluid Leak
Ethmoid Sinus
Follow-Up Studies
Foreign Bodies
Humans
Lacrimal Apparatus
Male
Olfaction Disorders
Optic Nerve
Orbital Fractures
Skull Base
Wounds, Penetrating

Figure

• 

  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).

Reference

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