Transorbital Penetrating Head Injury

We read the article by Satyarthee et al[1] “Transorbital penetrating head injury (TOPHI): Short series of two cases with review of literature” with great interest. In this important article, the authors report two cases of penetrating traumatic brain injury through the orbit. As authors stated that these injuries—transorbital penetrating head injury or better known as transorbital orbitocranial penetrating injury (TOPI)—are uncommon, although they have been discussed in the literature with many case reports.[2] [3] [4] [5] [6] [7] [8] [9] Even a case similar to the first case report (with almost similar findings) had been previously described in the literature by the same authors.[10] Before we label it as a case of TOPI, we need to clarify and understand the mechanism of these injuries and imaging findings. It has been described that in cases of TOPI, because of the orbital anatomy, it is expected that object most probably will take a posterior, medial, and superior trajectory thus forcing the bone fragments away from the orbit which can be easily recognized on computed tomographic scan.[11] [12] In the presented case, a closer look on figures 1a–d[1] shows that the object entered into the cranium almost through the mid-forehead and travelled laterally, superiorly, and posteriorly. Through its trajectory, it fractured both the walls of the frontal sinus, entered into the cribriform plate, and fractured the medial wall of the orbit. It is very important that fractured fragments from the medial orbital wall were displaced laterally, which means that the object was traversing outside the orbit. If it had been traversed through the orbit, a medial displacement of the fragments was expected. On the basis of the present findings, this case does not fit into the category of transorbital penetrating head injury rather than it is an another case of penetrating cranial and orbital injury.

• References

• 1 Satyarthee GD, Dawar P, Borkar SA, Sharma BS. Trans-orbital penetrating head injury (TOPHI): short series of two cases with review of literature. Indian J Neurotrauma 2014; 11: 49-52
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• 12 Arslan M, Eseoğlu M, Güdü BO. Demir I. Transorbital orbitocranial penetrating injury caused by a metal bar. J Neurosci Rural Pract 2012; 3: 178