Seizure caused by intraparenchymal hemorrhage from migration of mandibular dental wire through foramen ovale in a child: A case report

The foramen ovale is a structure that allows for the extracranial passage of multiple significant intracranial structures, most notably the mandibular branch of the trigeminal nerve (CN V(3)). Here we report the case of a 12-year-old male who presented to the emergency department (ED) with a two-day history of nausea and emesis and a one-day history of altered mental status. Prior to presentation, he started speaking only Spanish, which was unusual because he primarily speaks English. He was also showing signs of absence seizures. Computed Tomography (CT) showed his orthodontic wire had migrated and was entering his skull through the foramen ovale, terminating within the inferior temporal lobe. Associated with the wire was an intraparenchymal hemorrhage. Imaging indicated the sparing of the internal carotid artery and its major branches, suggesting the hemorrhage was likely venous in nature. The wire was then safely removed with no complications. Same day and follow-up neurologic exams all demonstrated no deficit in CN V(3) or any of the other surrounding structures. To our knowledge, this is the first case described in the literature in which a foreign object penetrated the skull floor through the foramen ovale.