Stab wound leading to sub lingual haematoma

We report a case of a sublingual haematoma and proptosis of the right eye as a result of penetrative injury to the suprazy-gomatic supratemporal fossa. The case was seen in the accident and emergency department at the Royal London Hospital (RLH). The case was referred to the anaesthetic and oral and maxillofacial unit, following neurosurgery and ophthalmology assessments.

The case highlights the need for a multi disciplinary approach to dealing with penetrative wounds in the craniofacial region. It is essential that all healthcare professionals have excellent working knowledge of the anatomy of the orbit and its asso-ciation with anatomical planes in the head and neck. (1) When diagnosing orbital compartment syndrome (also known as retrobulbar haemorrhage), radiographic findings should always be correlated to clinical signs and symptoms. Management of such a condition should be tailored to the individual. In this case medical management alone of 80mg of dexamethasone and 500mg of Mannitol was appropriate to enable a full recovery.

haematoma, airway obstruction, preoperative procedure, retrobulbar haemorrhage, floor of mouth

1. Lima V, Burt B, Leibovitch I, Prabhakaran V, Goldberg RA, Selva D. Orbital compartment syndrome: the ophthalmic surgical emergency. Surv Opthalmol 2009;54:441-9.

2. Natrella M, Duc L, Lunardi G, Cristoferi M, Fanelli G, Meloni T. Treatment of a transorbital penetrating injury: a particular endovascular approach. Interv Neuroradiol 2012;18:191-4.

3. Cashman E, Shandilya M, Amin M, Hughes J, Walsh M. Warferin- enduced sublingual hematoma mimicking Ludwig angina: conservative management of a potential life-threatening condition. Ear nose throat j 2011;90:E1.

4. Allen M, Perry M, Burns F. When is a retorbulbar haemorrhage not a retrobulbar heamorrhage? International J of Oral and Max fax surg 2010;39:1045-9.

5. Brucoli M, Arcuri F, Giarda M, Benech R, Benech A. Surgical management of posttraumatic intraorbital hematoma. J Craniofac Surg 2012;23:58-61.