Objectives: Report the clinical case of a patient with an atypical facial trauma, characterized by a transorbital penetrating toilet brush handle and discuss the injury characteristics and the multidisciplinary treatment applied. Such cases are exceptional, with no standardized therapeutic guidelines.
Methods: Examine the medical history, clinical presentation, and imaging findings of the patient. Comprehensive narrative highlighting the collaborative efforts between various specialties in addressing this unique challenge.
Results: A 67-year-old male with multiple comorbidities presented with an unusual penetrating facial trauma involving a toilet brush handle. The object entered through the medial canthus of the left orbit following a syncopal episode. Initial Computed Tomography (CT) imaging delineated the foreign body's trajectory traversing the ethmoidal lamina papyracea and cribriform plate, with its distal end located in the right frontal lobe. This imaging also revealed significant medial displacement of the left globe, which remained structurally intact, as well as frontobasal hemorrhagic contusions. A multidisciplinary intervention involving ophthalmology, neurosurgery, and maxillofacial surgeons was promptly undertaken. During the procedure, a craniotomy was performed to provide optimal access and visibility. The neurosurgical team initially worked to methodically push the foreign object in an anterior direction, simultaneously, the maxillofacial surgery team was positioned to receive and remove the object as it was guided out. This collaborative effort allowed for continuous monitoring and immediate intervention if any complications arose. Hemostasis was meticulously managed throughout the procedure, and the anterior cranial base was reconstructed following the removal of the object. Prophylactic administration of Ceftriaxone and Metronidazole was initiated to mitigate the risk of infection, as recommended by infectious disease specialists. Despite aggressive management and broad-spectrum antibiotic therapy, the patient's condition deteriorated due to multiple organ dysfunction syndrome secondary to septic shock. Unfortunately, he succumbed to these complications 14 days post-operation.
Conclusion: Unconventional facial traumas, such as those caused by domestic items like toilet brush handles, require careful assessment and a coordinated and tailored treatment strategy. The positive surgical outcome underscores the efficacy of a multidisciplinary approach, although it tragically contrasts with the patient's eventual demise, highlighting the potential for severe systemic complications following such injuries.
