Foreign Body Removal in the Craniomaxillofacial Complex: Indications, Techniques, and Treatment

Abstract

Foreign body migration in the deep spaces of the neck is particularly concerning due to the increased risk of damage to the great vessels and nerves. In addition, migration often cannot be easily predicted as objects may travel outside the confines of anatomic fascial planes. Although patients may be asymptomatic for years prior to presentation, timely removal of foreign bodies is ideal to preclude injury to important vascular and neurological structures as well as to prevent the development of recurrent infections and foreign body reactions. The authors report two cases of removal of migrated foreign bodies that presented at their institution. In one case, they report the use of intraoperative computed tomography (CT) imaging to help locate the position of a migrating dental needle. In another, they report the retrieval of a bullet fragment six months after the initial trauma. The classic method for retrieval of foreign bodies within the craniomaxillofacial complex centered around review of static radiographic imaging and a “blind,” broad exposure of the site in an attempt to localize and retrieve the material. This often resulted in iatrogenic injuries to surrounding structures or migration of the foreign body to a location, which may cause the patient additional harm. The utilization of intraoperative CT technology and computer navigation affords the craniomaxillofacial surgeon an additional tool for retrieval of these foreign bodies, often in a manner that affords minimally invasive surgical approaches, identification of vital structures within the operative field, and decrease in overall operative time for removal. Referral to institutions, which have this technology, should be considered early in the operative care of patients who encounter retained foreign bodies in the craniomaxillofacial region.