Patient had Knife like glass foreign body in face for a month without knowing about it- Case Report

Doctors were left in shock when they identified a knife-like glass shard penetrating the cheekbones of a teenage boy in Spain in his Computed Tomography (CT) scan report without knowledge of the patient. The case published in the Visual Diagnosis in Emergency Medicine has lately hit the headlines.

According to the case study reported in the journal, the 14-year-old boy visited the emergency department (ED) with a 1-month history of progressive difficulty opening his jaw and moderate pain when chewing. He reported having suffered a maxillofacial trauma 4 weeks earlier when he accidentally collided with a glass window after fainting.

He had previously presented to his local hospital, where a left facial hematoma had been drained and a 1-cm incised wound had been sutured on his left cheek. Initial examination showed a scar on the cheek and revealed a limitation to open his mouth (1 cm), with a deviation of the jaw to the left side and pain when moving the jaw. There was no facial paralysis or anesthesia The palpation of his oral cavity was normal. The rest of his medical history was not contributory.

An X-ray report that was initially obtained in the ED revealed a faint but well-defined rectangular image of approximately 3.5 cm in length in the tuberosity of the left maxilla. In order to find out what was that foreign particle, a noncontrast computed tomography (CT) scan was ordered.

X-ray revealing a partially radio-opaque Knife like glass shard stuck in the cheekbones of a teenage boy- Case Report

The CT scan revealed a radiopaque foreign body (FB), homogeneous and isodense with the bony cortex, compatible with a piece of glass measuring 3.5 cm maximum length 1 cm wide, which had the shape of a knife blade. It was located in the left deep temporal space, medial to the zygomatic arch, penetrating through the temporal and lateral pterygoid muscles, and placed between the coronoid process and the zygomatic-maxillary suture.

The patient was hospitalized and Oral and Maxillofacial Surgery was consulted. Given the anatomic location and the favorable surgical approach, a glass Foreign Body was extracted without complications with the aid of a surgical forceps through an intraoral approach under direct vision. The postoperative course was uneventful. Mandibular movements were recovered within the normal limit range. He has been followed for 6 months with no relevant clinical and radiographic findings.

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https://doi.org/10.1016/j.jemermed.2019.04.025