Endoscopic Removal of a Knife Penetrating Through the Eye into the Pterygopalatine Fossa

abstract

We describe an unusual case of a 12-year-old Palestinian boy who was stabbed through the left eyeball with a switchblade during a schoolyard soccer dispute. Following assessment at several West Bank Arab medical centers he was transferred, fully conscious, to Hadassah University Hospital. CT-scan sh...

owed the knife impaling the left orbit, continuing through the roof of the maxillary sinus and the posterior sinus wall into the pterigopalatine fossa, and penetrating deep into the pterygoid plates. CT-angiography showed that the knife was adjacent to the internal maxillary artery. Careful trial to remove the knife with moderate force was unsuccessful. A transnasal endoscopic approach to the skull base was used to dislodge the impacted knife which was subsequently removed through the orbit. The patient underwent enucleation with preservation of the ocular musculature. A prosthetic eye was fitted with excellent cosmetic results. This exceptional case highlights many important issues. Firstly, the prompt cooperation between Palestinian and Israeli health services resulted in a favorable outcome avoiding further needless suffering from this young boy. Furthermore, the importance of a coherent multidisciplinary trauma team cannot be overemphasized. This cooperation resulted in an innovative and minimally invasive treatment of a potentially severely disfiguring and possibly fatal trauma. Finally the value and versatility of endoscopic nasal and sinus surgery was once again reaffirmed, obviating the need for a Caldwell-Luc procedure.

detailed information