Penetrating Trans-Orbital Injury from a Brush Handle Lodged in the Infra-Temporal Fossa

The infra-temporal fossa (ITF) contains major vessels and cranial nerves. It is divided into two regions: the retro-styloid region, which includes cranial nerves IX and XII, the jugular foramen, and the internal carotid artery; and the pre-styloid region, which includes the trigeminal and facial nerves [1]. The penetration of trans-orbital injuries is rarely observed in emergency departments, and there are few reports on intracranial involvement in such injuries. However, nonprojectile penetrating ITF injuries due to foreign bodies are extremely rare [2]. We encountered a 24-year-old male who was admitted at our hospital with complaints of right eyeball pain, dizziness, and a foreign body in his right orbital area. His history revealed that he fell on a toilet brush after slipping in the toilet. On physical examination, the brush handle was observed to have entered the globe between the subtarsus and the infraorbital rim, with minimal bleeding at the wound margins (Fig. 1). Mouth opening was limited. Although the patient was unable to open his right eye, forced lid elevation revealed mydriasis. The right globe was inferiorly fixed, and ocular movement was limited in all directions. The object pressed the globe. Although hypoesthesia was detected in the area of the infra-orbital nerve, no step deformity was detected on the orbital rim upon palpation. Visual acuity could not be evaluated because of the brush handle. A direct Penetrating Trans-Orbital Injury from a Brush Handle Lodged in the Infra-Temporal Fossa