Saturday, December 14, 2013

An Unexpected Finding

This 21 year-old man was involved in a motorbike accident one year ago. At the time he was treated for multiple lacerations in a peripheral hospital. However, three months later, he developed a discharging sinus from the lateral side of his right eyelid and the eye became progressively higher.

Right eye higher than left and there was a discharging sinus (arrowed).

The local doctor did debridements a few times and put the patient on different courses of oral antibiotic but to no avail. A CT scans showed a mass in the orbital floor and was reported as possible bony granuloma. The patient was referred to my centre for removal of the granuloma.

CT scans showing a right orbital floor mass.

The orbital floor was explored by performing a lateral cantholysis to swing open the lateral orbital floor. To our surprise, a piece of wood with silver coating was found. The wood was integrated with the surrounding tissue and was removed piecemeal. The wound was irrigated with gentamicin and closed with lateral tarsal strip procedure.

A foreign body was found at the orbital floor during the exploration.

Wood removed by piece meal.

A large cavity was left after removal of the foreign body.

End of the surgery.

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