Penetrating orbital floor injury by an undetected foreign body: a case report

Orbital trauma can result in significant complications, particularly when accompanied by foreign body entrapment. Wooden foreign bodies are rare but carry a high risk of infection and chronic inflammation. In these cases, immediate surgical intervention is critical for restoring orbital anatomy and preventing complications. A 16-year-old male patient presented with a 2-month history of persistent pus discharge from his right cheek following facial trauma sustained from a fall. Initial management involved drainage of the abscess; however, the condition persisted. On examination, the patient exhibited infraorbital nerve paresthesia and an orbital floor fracture, and his history was notable for prior foreign body retrieval involving wooden fragments. Computed tomography revealed retained foreign bodies and discontinuity of the orbital floor. Surgical management included foreign body retrieval, the Caldwell-Luc procedure, and orbital floor reconstruction with mesh and platelet-rich fibrin placement. The patient's symptoms progressively improved over 6 months, with a reduction in paresthesia and no ocular or intracranial complications despite the delayed presentation. This case highlights the challenges of diagnosing and managing penetrating wooden foreign bodies in orbital trauma. It underscores the importance of prompt surgical intervention and interdisciplinary care to prevent potentially critical complications.