Management of Extensive Maxillofacial Trauma With Bony Foreign Body Within the Orbit From a Chainsaw Injury

Objective: The goal of this case report is to characterize injury patterns typical for chainsaw injuries to the face. We describe our approach to the soft tissue and skeletal injury patterns seen in these injuries. Methods: We present a case report of a traumatic chainsaw injury to the face. Results: A literature review of the typical injury patterns seen in chainsaw injuries to the face is discussed. Fractures to the bony orbit are on of the most common findings. Traumatic orbital fractures are often associated with other facial fractures, including those of the maxillary sinus and naso-orbital-ethmoid (NOE) region. There is a reported 47% incidence of lacrimal obstruction after NOE fractures, most caused by bone malposition or damage to the lacrimal sac or duct. Misdiagnosis of this injury pattern can lead to chronic patient morbidity. Conclusion: We present a case of traumatic orbital fracture with subsequent bony intrusion into the orbit, necessitating urgent exploration. The compound soft tissue and skeletal injury in this patient is typical for patients with associated lacrimal injury. Awareness of the injury patterns and treatment algorithms of these cases allows for appropriate assessment and intervention.