# Extraction of a Penetrating Nasocranial Foreign Body via Transnasal Endoscopic Approach

## TL;DR

A man with a fishing sinker lodged in his skull had it safely removed through a nasal endoscopic procedure after careful imaging.

## Contribution

The paper presents a successful case of transnasal endoscopic removal of a penetrating nasocranial foreign body.

## Key findings

- Computed tomography identified a metallic foreign body in the paranasal sinus, orbit, and middle cranial fossa.
- The foreign body was successfully extracted via transnasal endoscopic surgery without MRI due to its metallic nature.
- Postoperative recovery showed complete resolution of ophthalmoplegia and ptosis.

## Abstract

A 42‐year‐old male presented to our hospital with right ocular pain, diplopia, and difficulty opening his right eye. Three days earlier, while pulling up a fishing rod, a sinker struck his face. Since then, he developed decreased vision in his left eye and visited a local ophthalmologist the following day, where a retinal hemorrhage in the left eye was diagnosed. Two days later, he developed dull pain in his right eye and revisited the ophthalmologist on the third day after the injury. A computed tomography (CT) scan revealed a foreign body in the paranasal sinus, and he was subsequently referred to our hospital. Upon initial examination at our hospital, complete ophthalmoplegia and right‐sided ptosis were observed. CT scan revealed a metallic foreign body in the paranasal sinus, penetrating the orbit and middle cranial fossa. Considering that the foreign body was a metallic sinker, magnetic resonance imaging (MRI) was not performed. Cerebral angiography revealed no direct injury to the internal carotid artery. The foreign body was extracted using a transnasal endoscopic approach and was confirmed to be a fishing sinker. Postoperatively, intravenous steroids and antibiotic treatment were administered. Ophthalmoplegia and ptosis completely resolved.

In nasocranial foreign body cases, careful preoperative radiographic assessment is essential to evaluate intracranial location and cerebral injury and to guide procedural safety. Delayed neurological deficits may be treatable with solely transnasal endoscopy if they are not caused by direct brain injury.