Purpose: Transnasal and transorbital skull base penetrating injuries are relatively rare in clinical practice. To investigate the clinical presentations, imaging features, surgical management, and outcomes in patients, thereby offering a reference for the diagnosis and treatment of this condition. Methods: The clinical data for six patients with transnasal and transorbital skull base penetrating injuries, admitted to the Affiliated Hospital of Qingdao University from January 2017 to February 2023, were retrospectively analyzed; their clinical manifestations and treatment processes were comprehensively reviewed and summarized. Results: All six cases were male, with an average age of 48 years, ranging from 2 to 76 years old. The types of foreign bodies were all chopsticks, including one case of nasal foreign body and five cases of transorbital foreign body. The most common clinical manifestations were orbital hematoma and epistaxis, with preoperative vision loss in one case, ocular mobility disorder in three cases, and vision loss in four cases. After the diagnosis was confirmed by imaging, the skull base foreign body was removed by nasal endoscopic transnasal or transorbital approaches, and the foreign body was completely removed during the operation. Three patients with ocular mobility disorder recovered completely after surgery, and four patients with vision loss returned to normal 3 months after surgery. Meanwhile, all preoperative orbital hematoma, ocular pain, epistaxis, and nasal congestion disappeared. All patients had no abnormalities on sinus computed tomography scanning and good prognosis. Conclusion: Nasal endoscopic surgery is a minimally invasive, safe, and promising surgical technique.