Endoscope Assisted Removal of Peculiar Foreign Body of the Infratemporal Fossa

Abstract

Penetrating foreign body injuries to the infratemporal fossa represent rare emergent situations that require thoughtful approaches to perform safe extractions and thorough removal. Infratemporal fossa injuries can result in potentially life-threatening complications due to proximity of critical vascular and neurological structures and the skull base. We present a novel case of a traumatic penetrating injury of a bass fishing weight casting sinker through the right anterior and posterior maxillary sinus walls into the infratemporal fossa. A novel combined surgical approach was utilized using an endoscope through the traumatic wound into the maxillary sinus in order to have direct visualization of the infratemporal fossa for foreign body extraction. This provided visualization of critical structures and allowed for safe removal of the bass fishing weight without extensive incisions for surgical exposure. Rare penetrating facial trauma mechanisms involving the infratemporal fossa may require pre-operative planning with multidisciplinary team involvement. A fundamental understanding of critical anatomical structures is necessary to provide safe extraction and repair of resultant defects. A minimally invasive surgical approach may lead to decreased morbidity, although further research is required.