Traumatic Carotid-Cavernous Fistula in a Child with Nasal Penetrating Injury.

BACKGROUND

Traumatic penetrating carotid-cavernous fistula (CCF) is an uncommon complication of craniofacial trauma, particularly in pediatric patients. Prompt recognition is essential to prevent irreversible visual and neurological deficits.

CASE PRESENTATION: We describe a 2.5-year-old boy who sustained a penetrating nasal injury caused by a screwdriver. He initially presented with epistaxis and subsequently developed left-sided proptosis, chemosis, and restricted ocular motility. Early imaging studies were inconclusive, and orbital cellulitis was initially suspected.

DIAGNOSIS AND MANAGEMENT: A delayed diagnosis of a direct (Type A) CCF was ultimately confirmed using digital subtraction angiography (DSA). The patient underwent successful endovascular embolization combined with internal carotid artery (ICA) stenting.

CONCLUSION

This case highlights the need for a high index of suspicion for CCF in children presenting with atypical orbital findings following facial trauma, even when initial imaging doesn't reveal definitive pathology.