On the afternoon of March 4, 2023, City Children’s Hospital received L. TH. V. 9 years old, female, lives in Binh Tan district, HCMC. Taking the medical history recorded 30 minutes from the hospital admission, the child was riding a game electric bike in the park, when he reached the edge of the park corridor, he encountered an electric bike driver running up, both of them braked for the car. came to a sudden stop, resulting in the electric bicycle falling, causing the brake handle to hit the child’s left eye. After the accident, the child woke up, recorded a broken brake arm, stabbed in the left eye socket, bleeding heavily, was taken to the City Children’s Hospital by family members. Here, the child was examined by the doctors, had a CT scan of the brain without contrast, recorded acute bleeding in the brain parenchyma – a small amount of external and subdural hemorrhage in the left frontal region, ruptured the orbital surface. of the left frontal bone due to foreign objects entering the left eye socket, hematoma in the left maxillary sinus – hematoma in front of the left eyeball.
After inter-specialty consultation of eye, ENT, maxillofacial, neurosurgery, decided to report urgent surgery.
In the operating room: revealed that the sclera was torn right above the ceiling of the left orbit, the orbital bare bone was broken and there was a lot of brain tissue coming out at the place of the dural tear. Proceed to remove crushed brain tissue and broken skull fragments. The head of the round foreign body 1 x 1 cm penetrated into the brain parenchyma, causing cerebral hemorrhage around the brain. Expand the ceiling of the left eye socket to assist in pulling the foreign body out. Remove all contusion brain tissue and hematoma.
Then: open the skull and orbital bare bones, open the external angle and push the foreign body out of the skull from the orbit (depth about 25cm), open the conjunctiva 360 degrees, retract all rectus muscles, inspect the eye The sclera wall is seen to be intact. Suture conjunctiva, suture to shape the outer corner. suture to shape the lower eyelid margin by suturing the lower eyelid cartilage, stitching the lower eyelid margin with 3 nodules of gray line, eyelash root, skin. Stitching to shape the lower eyelid, stitching the skin of the cheekbones. After surgery, the child was transferred to the surgical resuscitation department for continued treatment of mechanical ventilation, analgesia, anti-brain edema, correction of electrolyte disturbances, acid-base status, antibiotics, and nutrition.
Results after nearly 2 weeks of active treatment, the child was weaned from the ventilator, breathed oxygen, then breathed air on his own, left eye alert and vision restored.
Doctor of K2 Nguyen Minh Tien
City Children’s Hospital
