Skip to main content
Advertisement

Main menu

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Other Publications
    • ajnr

User menu

  • Subscribe
  • Alerts
  • Log in

Search

  • Advanced search
American Journal of Neuroradiology
American Journal of Neuroradiology

American Journal of Neuroradiology

  • Subscribe
  • Alerts
  • Log in

Advanced Search

  • Home
  • Content
    • Current Issue
    • Publication Preview--Ahead of Print
    • Past Issue Archive
    • Case of the Week Archive
    • Classic Case Archive
    • Case of the Month Archive
    • COVID-19 Content and Resources
  • For Authors
  • About Us
    • About AJNR
    • Editors
    • American Society of Neuroradiology
  • Submit a Manuscript
  • Podcasts
    • Subscribe on iTunes
    • Subscribe on Stitcher
  • More
    • Subscribers
    • Permissions
    • Advertisers
    • Alerts
    • Feedback
  • Follow AJNR on Twitter
  • Visit AJNR on Facebook
  • Follow AJNR on Instagram
  • Join AJNR on LinkedIn
  • RSS Feeds
OtherHEAD AND NECK

Transoral Penetration of a Half-Split Chopstick between the Basion and the Dens

Seijiro Taniura, Kyoko Tatebayashi, Keiichi Akatsuka, Atsumi Takenobu, Hideki Kamitani, Masayuki Yokota and Takashi Watanabe
American Journal of Neuroradiology May 2004, 25 (5) 871-872;
Seijiro Taniura
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Kyoko Tatebayashi
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Keiichi Akatsuka
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Atsumi Takenobu
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Hideki Kamitani
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Masayuki Yokota
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Takashi Watanabe
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • Article
  • Figures & Data
  • Info & Metrics
  • References
  • PDF
Loading

Abstract

Summary: A 6-year-old girl was admitted for transoral penetrating injury by a half-split chopstick. Subsequent CT imaging examinations showed that the chopstick had passed between the basion and the dens and reached the subarachnoid space just at the medulla oblongata. A sagittal reconstructed CT scan was useful for the evaluation of the injury. Imaging findings and their clinical relevance are discussed.

Craniocerebral penetrating injury by a half-split chopstick sometimes occurs in Japan (1–6), especially in children (1–5). We describe a patient with transoral penetrating injury by a half-split chopstick, passing between the basion and the dens. To our knowledge, this type of penetrating injury had not been reported in the literature.

Case Report

While eating cotton candy, the patient, a 6-year-old girl, fell with a half-split chopstick in her mouth. On admission to the emergency department of our hospital, she had no neurologic deficits. The half-split chopstick was fixed tightly, penetrating the soft palate. We performed CT immediately without sedation. CT scans were obtained at a voltage of 120 kV, a tube current of 300 mA, 0.5 s per rotation, a detector row beam collimation of 1 mm, helical pitch of 3.5, and a field of view of 21.75 cm by using a multidetector helical CT scanner (Aquilion Multi; Toshiba Medical, Tokyo, Japan). The chopstick was fixed with a string, to prevent migration. The CT scan setting with the bone window demonstrated the chopstick as a low-attenuation area in the nasopharyngeal wall and, moreover, in front of the medulla oblongata (Fig 1). Obvious intracranial hemorrhage was not observed.

Fig 1.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 1.

CT scan with the bone window setting demonstrating the chopstick as a low-attenuation area in the nasopharyngeal wall and in front of the medulla oblongata.

Reconstructed sagittal CT images revealed the accurate localization of the chopstick (Fig 2). The half-split chopstick penetrated into the soft palate just above the uvula to the nasopharyngeal space and tore the upper pharyngeal wall between the basion and the dens and then reached the subarachnoid space at the medulla oblongata. After CT was performed, the patient began to cry and move her head and mouth. We then decided to remove the chopstick without further examinations, because of the risk of injury to the brain stem.

Fig 2.
  • Download figure
  • Open in new tab
  • Download powerpoint
Fig 2.

Reconstructed CT scan revealing a clear image of the half-split chopstick as low-attenuation line, which penetrated into the soft palate just above the uvula, through the nasopharyngeal space, into the upper pharyngeal wall between the basion and the dens, and then reached the subarachnoid space at the medulla oblongata.

Emergent surgery was performed via a transoral approach under general anesthesia. Preoperatively, we did not evaluate vascular injury. Because the top of a half-split chopstick was blunt (ie, 5 mm × 5 mm) and no hemorrhaging was apparent around the tip of the chopstick, it was unlikely that penetration would result in direct vascular injury. Moreover, there could be no major artery at the midline of the lower part of the medulla oblongata, where the top of chopstick reached. If it had been necessary, however, microscopic surgical intervention would have been performed.

During the operation, the half-split chopstick was fixed firmly, and strong force was needed to remove it manually. CSF and a small amount of blood were noted after its removal, but their leakage stopped with compression alone. The posterior pharyngeal mucous membrane was then closed with two stitches of absorbable suture. Intravenous antibiotic therapy was administered to prevent postoperative bacterial meningitis. A subsequent lumbar puncture demonstrated mild bacterial meningitis, but the patient was discharged 3 weeks after her injury free of infection or CSF leakage. On discharge, she wore a soft neck collar for immobilization. Her neck was stable, with dynamic study demonstrating no abnormal movement of the dens.

Discussion

In the literature, craniocerebral penetrating injury in childhood consisted of stab wounds, encountered as accidental injuries by pencils (7), screwdrivers (5), sewing needles (5, 8), chopsticks (1–5), knives (9), scissors (10), and so on. Whenever children hold objects in their mouths, oral injury is likely. In our case, an unusual transoral penetration between the basion and the dens occurred. To the best of our knowledge, the literature contains no reports of this type of injury.

Because of the porosity of the wood, a dry chopstick contains a considerable amount of air. As such, a CT scan shows it as a low-attenuation structure. Once water is absorbed from surrounding tissues, its attenuation could be changed (1–3), resulting in misdiagnosis. If small foreign bodies migrate into soft tissues, still greater attention is needed. In such a case, MR imaging should be performed. In the case of our patient, the reconstructed sagittal image provided us with a clear picture as the low-attenuation line, which demonstrated accurate localization of the half-split chopstick that penetrated the dura in front of the medulla oblongata.

Preoperatively, we supposed that major vascular injury had not occurred. First, the top of a half-split chopstick was obtuse and blunt, so direct injury to the vessel was unlikely. Second, there could not be basilar artery at the medulla oblongata at the position of the chopstick. Third, the patient had no neurologic deficits, which indicated that major vessels were not damaged. In fact, intraoperatively, a small amount of blood was observed after its removal, but further bleeding did not occur. Postoperatively, she recovered well without major complications.

In this case, the reconstructed sagittal CT image gave us a great deal of useful information about the accurate location of the chopstick and, consequently, aided in treatment.

References

  1. ↵
    Ishikawa E, Meguro K, Yanaka K, et al. Intracerebellar penetrating injury and abscess due to a wooden foreign body: case report. Neurol Med Chir (Tokyo) 2000;40:458–462
    CrossRefPubMed
  2. Kuroiwa T, Tanabe H, Ogawa D, et al. Chopstick penetration of the posterior cranial fossa: case report. Surg Neurol 1995;4368–4369
  3. ↵
    Matsuyama T, Okuchi K, Nogami K, et al. Transorbital penetrating injury by a chopstick: case report. Neurol Med Chir (Tokyo) 2001;41:345–348
    PubMed
  4. Suzuki H, Saitoh K, Inoue S, et al. Rapid sequence induction for penetrating head injury from a chopstick in a paediatric patient. Paediatr Anaesth 2002;12:88–89
    PubMed
  5. ↵
    Tomita T, Miwa T. [Penetrating craniocerebral injuries in childhood-report of three cases.] Nervous Syst Children 1978;3:229–234 (in Japanese)
  6. ↵
    Yamamoto I, Yamada S, Sato O. Unusual craniocerebral penetrating injury by a chopstick. Surg Neurol 1985;23:396–398
    PubMed
  7. ↵
    Dujovny M, Osgood CP, Maroon JC, et al. Penetrating intracranial foreign bodies in children. J Trauma 1975;15:981–986
    PubMed
  8. ↵
    Ameli NO, Alimohammadi A. Attempted infanticide by insertion of sewing needles through fontanels: report of two cases. J Neurosurg 1970;33:721–723
    PubMed
  9. ↵
    Tiwari SM, Singh RG, Dharker SR, et al. Unusual craniocerebral injury by a key. Surg Neurol 1978;9:267
    PubMed
  10. ↵
    Dolling JA, Bell WE, Whitehurst WR. Penetrating skull wound from a pair of scissors: case report. J Neurosurg 1967;26:636–638
    PubMed
  • Received May 21, 2003.
  • Accepted after revision August 23, 2003.
  • Copyright © American Society of Neuroradiology
PreviousNext
Back to top

In this issue

American Journal of Neuroradiology: 25 (5)
American Journal of Neuroradiology
Vol. 25, Issue 5
1 May 2004
  • Table of Contents
  • Index by author
Advertisement
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on American Journal of Neuroradiology.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Transoral Penetration of a Half-Split Chopstick between the Basion and the Dens
(Your Name) has sent you a message from American Journal of Neuroradiology
(Your Name) thought you would like to see the American Journal of Neuroradiology web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Transoral Penetration of a Half-Split Chopstick between the Basion and the Dens
Seijiro Taniura, Kyoko Tatebayashi, Keiichi Akatsuka, Atsumi Takenobu, Hideki Kamitani, Masayuki Yokota, Takashi Watanabe
American Journal of Neuroradiology May 2004, 25 (5) 871-872;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Transoral Penetration of a Half-Split Chopstick between the Basion and the Dens
Seijiro Taniura, Kyoko Tatebayashi, Keiichi Akatsuka, Atsumi Takenobu, Hideki Kamitani, Masayuki Yokota, Takashi Watanabe
American Journal of Neuroradiology May 2004, 25 (5) 871-872;
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • Abstract
    • Case Report
    • Discussion
    • References
  • Figures & Data
  • Info & Metrics
  • References
  • PDF

Related Articles

  • No related articles found.
  • PubMed
  • Google Scholar

Cited By...

  • The Toothbrush: A Rare but Potentially Life-Threatening Cause of Penetrating Oropharyngeal Trauma in Children
  • Crossref
  • Google Scholar

This article has not yet been cited by articles in journals that are participating in Crossref Cited-by Linking.

More in this TOC Section

  • Correlation of Apparent Diffusion Coefficient at 3T with Prognostic Parameters of Retinoblastoma
  • Parathyroid Lesions: Characterization with Dual-Phase Arterial and Venous Enhanced CT of the Neck
  • Comparison of Contrast Effect on the Cochlear Perilymph after Intratympanic and Intravenous Gadolinium Injection
Show more HEAD AND NECK

Similar Articles

Advertisement

News and Updates

  • Lucien Levy Best Research Article Award
  • Thanks to our 2022 Distinguished Reviewers
  • Press Releases

Resources

  • Evidence-Based Medicine Level Guide
  • How to Participate in a Tweet Chat
  • AJNR Podcast Archive
  • Ideas for Publicizing Your Research
  • Librarian Resources
  • Terms and Conditions

Opportunities

  • Share Your Art in Perspectives
  • Get Peer Review Credit from Publons
  • Moderate a Tweet Chat

American Society of Neuroradiology

  • Neurographics
  • ASNR Annual Meeting
  • Fellowship Portal
  • Position Statements

© 2023 by the American Society of Neuroradiology | Print ISSN: 0195-6108 Online ISSN: 1936-959X

Powered by HighWire