穿透性颌面部创伤伴金属异物经上颌迁移至蝶窦：一例罕见病例

文献信息

中文摘要

本病例报告详细描述了一例罕见且可能危及生命的损伤，该损伤最初在农业活动中发生的颌面部创伤中被忽视。一名19岁男性在右侧颧部受伤2天后因头痛和乏力就诊于急诊科，此前该伤口已缝合但未进行进一步评估。进行了全面的临床检查，发现双侧眶周肿胀，伴有右眼结膜下出血和水肿。影像学检查显示存在一个巨大的新月形金属异物，其尖端位于前颅底下方，穿透蝶窦并位于垂体下方。异物基底部水平延伸至中鼻甲邻近区域。多层计算机断层扫描血管成像显示其与关键神经血管结构（包括上颌动脉分支）关系密切。在全身麻醉下，通过鼻外经上颌入路，利用创伤切口进行了手术取出。经过细致分离，到达异物并通过向外旋转技术小心将其取出。本病例强调了在面部创伤中全面临床评估、详细病史采集和先进影像学检查的至关重要性，因为表面看似无害的伤口可能隐藏潜在并发症。在未完全明确诊断的情况下进行撕裂伤一期缝合，可能将患者置于距离关键神经血管结构仅数毫米的危险之中。在对创伤性面部撕裂伤进行一期缝合前，需要详细的病史、系统检查和适当的辅助检查。

英文摘要

This case report details a rare and potentially life-threatening injury of an initially overlooked maxillofacial trauma sustained during agricultural activity. A 19-year-old male presented to the emergency department with a headache and fatigue, 2 days following a right malar injury that had been previously sutured without advanced evaluation. A thorough clinical examination was conducted, which revealed the presence of periorbital swelling on both sides, accompanied by a right subconjunctival hemorrhage and chemosis. Radiographic imaging revealed the presence of a substantial, crescent-shaped metallic foreign body with its tip lodged just beneath the anterior skull base, penetrating the sphenoid sinus and lying inferior to the hypophysis. The base of the foreign body extended horizontally into the region adjacent to the middle nasal concha. Multislice computed tomography with angiography revealed its close proximity to critical neurovascular structures, including branches of the maxillary artery. Surgical removal was performed under general anesthesia via an extra-nasal transmaxillary approach, utilizing the trauma incision. Following meticulous dissection, the foreign body was reached and carefully extracted through an executed outward rotation technique. This case emphasizes the vital necessity for thorough clinical evaluation, detailed history-taking, and advanced imaging in the context of facial trauma, where superficially innocuous wounds may harbor latent complications. Primary closure of laceration without full diagnostic clarity risks sealing the patient in danger just millimeters from vital neurovascular structures. A detailed history, systematic examination and proper investigations are needed before primary closure of traumatic facial lacerations.