隆鼻術に用いられた象牙インプラントによる稀有な穿通性頭部外傷の1例と文献的考察

An Extremely Rare Case of Penetrating Head Injury Caused by a Nasal Implant Made of an Ivory Chip and a Review of the Literature

穿通性頭部外傷はわが国では非常に稀である。今回われわれは美容目的の隆鼻術で皮下に埋め込まれた象牙が頭蓋内に穿通した極めて稀な症例を経験した。症例は69歳女性，精神疾患を罹患し，突発的に窓から飛び降り，顔面を強打した。埋め込まれた象牙は前頭洞から左前頭葉に刺入しており，これを外科的に鼻根部から抜去し，副鼻腔の十分な消毒と粘膜の処理，頭蓋骨膜による前頭蓋底の修復および硬膜を密に縫合し閉創した。術後は感染症などを併発することなく良好な経過をたどり，術後30病日に原疾患の治療のため転院した。これまでわが国での穿通性頭部外傷について体系的にまとめた報告は皆無であり，文献的考察を加えて報告する。

Abstract

Although penetrating head injuries are very rare in Japan, an extremely rare case is reported in which an ivory chip, embedded in the subcutaneous tissue by a cosmetic rhinoplasty, penetrated the cranium. A 69-year-old woman with a psychiatric disorder suddenly jumped down from a window and bruised her face. The ivory chip went into her left frontal lobe via the frontal sinus. At surgery, it was completely removed via the nasion. There were no postoperative complications after adequate frontal sinus repair and closure of dura mater with a piece of pericranium. The literature dealing with Japanese penetrating head injuries was also reviewed.

(Received May 27, 2015; Accepted December 1, 2015; Published June 1, 2016)