Retained Facial Foreign Body Following Trauma in a Child

Retained Facial Foreign Body Following Trauma in a ChildAbstractTraumatic injuries in orofacial share often drive alien bodies in the soft tissues. They are secondary to penetrating or abrasive trauma resulting in bleeding and deep wound. The outside(prenominal) body may sometimes remain unnoticed. This case report is of a 32 month old male affected role who reported to the part of Pedodontics and handicap dentistry with complain of dagger prick injury on right side of the face. On palpation, linear mass on the right cheek voice measuring about 3-4 cm in length with small eruption on skin suggestive of healed inauguration was evaluated. Soft tissue ultrasonography (USG) was advised along with blood investigation. Soft tissue USG did not disclose any foreign body. Blood investigation was normal. Surgical exploration revealed a thorn measuring 17mm in size. The wound was debrided and sutures placed at the office of incision. The 6-month clinical follow-up revealed uneventfu l soft issue healing. Early and definite diagnosing correlating clinical and radiologic examination is important for conservative management of such lesion thus eliminating potential risk of developing larger infection.Key-words Paediatric trauma, soft tissue injuries, maxillofacial injuries triggerTrauma is the leading cause of morbidity and mortality among children worldwide.1Soft tissue injuries are more common than fractures in children who have uphold facial trauma, particularly in younger children whose facial skeletons are resistant to fracture.2However, in comparison with adults, maxillofacial fractures in children are relatively uncommon due to physiological and environmental factors.3-4According to Nrholt et al.5, fractures of the pediatric maxillofacial skeleton are rare due to the resiliency of their bones, the relatively small size of their body in proportion to the head and the comparatively protected lifestyle of children.During sign assessment of any facial injury, it is important to review the mechanism and time of injury and determine whether it was witnessed. Knowing what caused the injury leave be valuable during later exploration and debridement of wounds and the prediction of subsequent wound healing.Every effort should be made to cleanse the wound and remove all foreign material this may have to be done in the operating room low anesthesia. These retained foreign bodies which are often missed at initial evaluation result in inflammation, ichor discharge, and toxicity and delayed healing of wounds.Case descriptionA 32 months old malepatient reported to the Department of Pedodontics and Preventive Dentistry, College of Dental Surgery, B.P Koirala Institute of Health Sciences, Dharan, Nepalwith complaint of thorn prick injury on the right side of. (Figure1). The patient had fallen from a tree diagram and was injuredtwo months back. No treatment was sought for the condition at the time of trauma. Medical history was not signifi cigarett et. On examination, a palpable linear mass on the right cheek region measuring about 3-4 cm in length with small eruption on skin suggestive of healed opening was evaluated. The mass was movable upon palpation in all directions. There was no pain or tenderness upon palpation. There was no history of fever and pus discharge. Soft tissue ultrasonography (USG) was advised along with blood investigation. Soft tissue USG did not disclose any foreign body. Blood investigation was normal.On the basis of clinical findings, a surgical exploration was planned under local anesthesia to remove the foreign body. Intra-dermal local anesthesia (Lignocaine hydrochloride 2%, epinephrine 1200000) was administered. A small incision was given at the most fluctuant point of the scar with the help of a B.P blade. The lesion was explored with curved artery forceps and a wooden piece which was curved at one end and pointed at the other end and measuring 17mm was removed. (Figure2). The lesion was cleansed and irrigated with Betadine (Povidone-Iodine) solution and saline. A 3-0 silk suture was placed at the site of incision (Figure 3). The patient was prescribed with antibiotic and analgesic and was recalled after one week for suture removal.The patient was followed up till 6 months and the healing was uneventful (Figure 4)DiscussionSoft tissue injuries, whether isolated or in combination with other injuries, are among the most common traumatic craniofacial injuries encountered by emergency department personnel and plastic surgeons. These injuries account for nearly 10% of all emergency department visits.6, 7, 8Unintentional injury, defined as every disability occurring under accidental circumstances, is a significant health problem in children in the general practice, accounting for 9% of all new health problems in children.9Divided into triplet overlapping aesthetic subunits (infraorbital, preauricular, and buccomandibular), the cheeks are by surface area the largest subunit of the face. This size correlates with both a high frequency of injury to the cheek and central structures as well as a multitude of approaches that can be used for posttraumatic reconstruction.10Foreign bodies can penetrate soft tissues through open wounds and laceration sustained during trauma or by direct impact against them. Such wounds harboring foreign bodies may appear to be deceptively minor and may not be accompanied by any major symptoms. But if these foreign bodies are left undetected in the tissues they can result in serious here and now days, months or years after initial trauma.11Penetrating retained wooden bodies acts as foreign body, ordinarily dirty and carry many microorganisms.12Because of their porous union and organic nature, provide a good medium for the growth of the microbial agents. Infection resulting from the retained wooden body may lead to complications such as abscess and fistula formation13.The case presented in this report also had a retained wooden for eign body for a period of two months but the patient did not develop any complications as such except presence of a linear scar on the cheek.The foreign body removal can be delayed in approximately one third of all foreign bodies, because they are initially radiologically missed or misdiagnosed.14Occasionally, foreign bodies can be retained for some time causing persistent and distressing symptoms.15It is often difficult to remove foreign bodies in the head and neck because they are usually near vital structures, or the difficult access.16The careful assessment is required for the identification and location of the retained foreign body, which is essential for the surgical removal.17Early diagnosis and definitive treatment as well as good postoperative wound care are important when dealing with soft tissue injuries. Since the initial assessment of these patients may involve a Dentists, a properknowledge of the diagnosis and management of soft tissue trauma is necessary.