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Unusual delayed sequel to facial trauma
Radiology forum
Unusual delayed sequel to facial trauma
A
44-year-old man recently came to the oral surgery department at Guy’s Hospital complaining of a dull ache in his right maxilla. Clinical examination showed no abnormalities, however, a radiograph revealed what appeared to be a foreign body that extended transversely from the right maxillary antrum across the floor of the nose to the posterior aspect of the left hard palate (Fig. 1). Further questioning revealed that the patient had been assaulted while walking along a road in central London approximately 10 years ago. He had sustained considerable facial bruising but had not sought any medical treatment. In view of the fact that the patient had a great deal of pain associated with the visible foreign body, he was taken to the operating room. A segment of metal was removed from the antrum via a Caldwell-Luc approach. Closer examination of the metallic fragment indicated that it was a 10 cm long steel nail. It was extremely rusty and was associated with a granulomatous reaction where it lay in the tissues. It is interesting to speculate how this nail ended up embedded in the patient’s maxilla. A small scarred perforation visible on the skin may have been the entry point of the nail over the right side of the patient’s face. He did in fact remember being hit on the cheek with a “knuckle duster.” It is probable that the nail was held in the assailant’s fist as a weapon and was used to stab the patient’s face. This unusual sequel to assault had remained totally symptomless for a decade. Presumably, gradual rusting of the steel nail and an adjacent tissue reaction eventually caused the
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Fig. 1. Occipitomental radiograph shows foreign body extending from right maxilla to left hard palate. discomfort attention.
for which
the patient
sought medical
N A4 Girdler, FDSRCS, FFDRCSI Department of Oral and Maxillofacial Surgery Guy’s Hospital Medical and Dental School London SE1 9RT England
Unusual delayed sequel to facial trauma
A
44-year-old man recently came to the oral surgery department at Guy’s Hospital complaining of a dull ache in his right maxilla. Clinical examination showed no abnormalities, however, a radiograph revealed what appeared to be a foreign body that extended transversely from the right maxillary antrum across the floor of the nose to the posterior aspect of the left hard palate (Fig. 1). Further questioning revealed that the patient had been assaulted while walking along a road in central London approximately 10 years ago. He had sustained considerable facial bruising but had not sought any medical treatment. In view of the fact that the patient had a great deal of pain associated with the visible foreign body, he was taken to the operating room. A segment of metal was removed from the antrum via a Caldwell-Luc approach. Closer examination of the metallic fragment indicated that it was a 10 cm long steel nail. It was extremely rusty and was associated with a granulomatous reaction where it lay in the tissues. It is interesting to speculate how this nail ended up embedded in the patient’s maxilla. A small scarred perforation visible on the skin may have been the entry point of the nail over the right side of the patient’s face. He did in fact remember being hit on the cheek with a “knuckle duster.” It is probable that the nail was held in the assailant’s fist as a weapon and was used to stab the patient’s face. This unusual sequel to assault had remained totally symptomless for a decade. Presumably, gradual rusting of the steel nail and an adjacent tissue reaction eventually caused the
264
Fig. 1. Occipitomental radiograph shows foreign body extending from right maxilla to left hard palate. discomfort attention.
for which
the patient
sought medical
N A4 Girdler, FDSRCS, FFDRCSI Department of Oral and Maxillofacial Surgery Guy’s Hospital Medical and Dental School London SE1 9RT England