Lacrimal Gland Fistula following Severe Head Trauma.

We aim to present a unique case with discharging lacrimal gland fistula secondary to severe head trauma by an animal. A 9-year-old girl presented with serous fluid discharge from a cutaneous fistula in the left orbital region. The patient had history of surgery for traumatic frontal bone fracture and skin laceration in the superior orbital rim three weeks earlier. She underwent a complete ophthalmological examination and there was no anterior segment or fundus pathology. The orifice of the fistula was detected in mediolateral part of the left superior orbital rim and fluid secretion was increasing with irritation of the left eye. Neurosurgical complications were excluded and radiological assessment was nonremarkable. The patient's legal representatives were informed and lacrimal gland fistulectomy was planned. However, the fistula was self-closed one week after initial ophthalmological examination, and the patient had no symptoms. In conclusion, traumatic injuries of superior orbital region should be carefully evaluated and wounds should be well closed to prevent consecutive lacrimal gland fistula.

[Infection in patients with isolated head injury: risk factors and the impact on treatment cost]. / Izole kafa travmali olgularda enfeksiyon: Risk etkenleri ve tedavi maliyeti üzerine etkisi.

BACKGROUND: We aimed to determine risk factors and the impact on treatment cost of infection in patients with isolated head injury. METHODS: Data acquired from 299 patients (239 males, 60 females; mean age 35,1±23,2 years) with isolated head trauma who were hospitalized for more than 72 hours at Trakya University Training and Research Hospital between 2001-2007 were evaluated retrospectively. Data including age, gender, initial neurological examination, radiological findings, duration of hospitalization, need for surgery, cost of infection treatment, total cost of care, and outcome scores were determined. Two groups divided according to the development of infection were compared for risk factors and the impact of infection on the cost of treatment. RESULTS: In the group of patients with infection, the mean Glasgow Coma Scale score at delivery was lower; anisocoria, light reflex loss, lateralized deficit, skull base fracture, subdural hematoma, and cerebral edema findings were more frequent. A four-times longer hospital stay, 10-times higher total cost and a significantly increased mortality rate were determined in this group. For the patients with light head injury, in the group of patients with infection, the mean age was found to be higher. CONCLUSION: For patients with isolated head injury, there are some risk factors for the development of infection that increase the hospitalization duration, total cost of care and mortality rates.