Penetrating maxillofacial trauma with transmaxillary migration of a metallic foreign body to the sphenoid sinus: A rare case.

This case report details a rare and potentially life-threatening injury of an initially overlooked maxillofacial trauma sustained during agricultural activity. A 19-year-old male presented to the emergency department with a headache and fatigue, 2 days following a right malar injury that had been previously sutured without advanced evaluation. A thorough clinical examination was conducted, which revealed the presence of periorbital swelling on both sides, accompanied by a right subconjunctival hemorrhage and chemosis. Radiographic imaging revealed the presence of a substantial, crescent-shaped metallic foreign body with its tip lodged just beneath the anterior skull base, penetrating the sphenoid sinus and lying inferior to the hypophysis. The base of the foreign body extended horizontally into the region adjacent to the middle nasal concha. Multislice computed tomography with angiography revealed its close proximity to critical neurovascular structures, including branches of the maxillary artery. Surgical removal was performed under general anesthesia via an extra-nasal transmaxillary approach, utilizing the trauma incision. Following meticulous dissection, the foreign body was reached and carefully extracted through an executed outward rotation technique. This case emphasizes the vital necessity for thorough clinical evaluation, detailed history-taking, and advanced imaging in the context of facial trauma, where superficially innocuous wounds may harbor latent complications. Primary closure of laceration without full diagnostic clarity risks sealing the patient in danger just millimeters from vital neurovascular structures. A detailed history, systematic examination and proper investigations are needed before primary closure of traumatic facial lacerations.