Transorbital intracranial impalement injuries by wooden foreign bodies: Clinical, radiological and forensic aspects

Facial impalement injuries involve the danger of diagnostic pitfalls. Even if the penetrating object extends into the cranial cavity, the clinical symptoms and the radiological signs may be uncharacteristic. In order to illustrate the diagnostic problems, two cases of accidental impalement are reported. In both of them, a wooden foreign body penetrated via the orbita into the cranium and remained undetected at first. Imaging by CT and MRI is presented and compared with regard to the respective diagnostic validity of these methods. Due to its specific anatomic configuration, the orbita constitutes a predilective pathway for low-velocity foreign bodies entering the skull. Based on the clinical data and the radiological findings, transorbital impalement wounds inflicted by wooden objects are discussed under neurosurgical and medicolegal aspects.