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Large splinter lodged in woman’s cheek required four surgeries: case study

TORONTO — A large wood splinter lodged in a woman’s cheek was initially missed by doctors and required four surgeries to remove, prompting a warning not to ignore signs of a foreign object that may have stayed in the body.

The case report about the unnamed Indian woman was published this month in the British Medical Journal.

The 23-year-old woman suffered blunt force trauma over her left cheek from a wooden stick in June 2017, causing swelling and a one-centimetre cut just below her left eyelid.

A week later the woman noticed discharge from the cheek wound and visited a local hospital where a doctor performed a minor surgery and removed a small wooden chip from her cheek.

She was prescribed medication, but once she finished the course her cheek wound developed discharge again and she endured a second surgery.

The woman was eventually referred to Lokmanya Tilak Municipal Medical College and General Hospital in Mumbai, where she was sent for a CT (computed topography) scan.

“My doctors went through the scan and said no foreign body was seen but told me that I will be taken for surgery to see my wound and also look for any residue of foreign body,” the patient said in the case study.

During surgery three more pieces of wood were removed from her wound.

“A month later again I developed swelling over the same site but with slight blurring of vision,” she said.

“I was very sad and went back to my doctor. This time my doctor was very sure of the foreign body and took me to the radiologist and told them about the certainty. I got my scan repeated, to my surprise my doctors said that the CT scan showed a huge foreign body inside.”

The patient had another surgery and when she woke up her doctors showed her a seven-centimetre long wooden stick, which was removed from her cheek. Two months later, her wound had finally healed.

“I’m really grateful to all my doctors whose insight and prompt decision helped me from losing my vision,” she said.

The report authors noted that the “possibility of a retained foreign body should always be considered when a patient presents with a history of orbital (around the eye) trauma.”

“Meticulous history-taking, thorough examination, high index of suspicion along with a low threshold for imaging studies are essential to make a timely diagnosis of a retained intraorbital foreign body,” the authors wrote.

“The prompt removal with the appropriate approach may not only save the eye but also the life of the patient.”

The most common foreign bodies found in patients are usually metallic or glass, according to the case study authors.

“As these are inorganic, they incite little inflammatory reaction. On the contrary, organic foreign bodies like wood lead to an acute inflammatory reaction and dire consequences if not removed,” the authors said.

“No imaging modality, be it a CT or MRI (magnetic resonance imaging), can detect a wooden foreign body with 100 per cent sensitivity.” 

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