Buried Beneath the Surface: CT Limitations in Detecting Dry Wooden Facial Foreign Bodies

Abstract

Background: Organic foreign bodies in the maxillofacial region are often missed due to their radiolucent nature. Dry wood is particularly challenging as its density on CT scans can mimic air or fat. Case Description: A 62-year-old female presented with persistent facial swelling and pus discharge two weeks after colliding with a tree. Despite clinical suspicion, a preoperative CT scan showed no detectable foreign object. Management: Based on the traumatic history and persistent infection, surgical exploration was performed. A 3.5 cm wooden fragment was identified and extracted from the subcutaneous tissue. The patient recovered fully following debridement and antibiotic therapy. Discussion: Dry wood typically exhibits low Hounsfield Units, making it nearly invisible on standard CT settings. While adjusted CT windowing or MRI can improve detection, these materials are frequently overlooked during initial assessment. Conclusion: A negative CT scan does not rule out wooden foreign bodies. Clinicians must maintain a high index of suspicion in organic trauma cases; surgical exploration remains the definitive diagnostic and therapeutic approach.