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1.  Postoperative discomfort of dental rehabilitation under general anesthesia 
Objective: To find out postoperative discomfort in children undergoing dental rehabilitation under general anesthesia (DRGA).
Methods: This study involved 78 (4 to 10 year-old) healthy patients who were scheduled for DRGA and were needed extensive dental treatment because of severe caries, and showed high dental fear and/or behavioral management problems. The children had to be fit for DRGA administration by fulfilling the American Society of Anesthesiologists physical status I or II and no associated mental health or communication problems. Data were collected by structured interview either face to face (immediately post operation) or using a telephone (post operation after discharge). One of the study’s investigators recorded all data related to the immediate postoperative period during the child’s stay in the post-anesthesia care unit (PACU). The questionnaire consisted of questions related to postoperative problems experienced by the patient in the period after their day-stay attendance. The questionnaire, consisting of questions regarding and generally related to the child’s activities. In addition, pain was assessed using the face, legs, activity, cry, consolability (FLACC) scale.
Results: The prevalence of postoperative problems was 46 out of 78 (59%). The mean FLACC score was 1.8 (SD=2.1). Some of the patients having more than one reported problem. Forty-one percent of the children showed nasal discomfort (P<0.01). Thirty-three percent and 43% of the children experienced throat or mouth discomfort. The most common experienced postoperative symptom after DRGA was bleeding. Nasal bleeding, however, was an uncommon complication and did not cause serious morbidity or mortality in children intubated nasotracheally. In addition, postoperative discomfort was related to number of the extractions. Children who had 4 or more extractions were more likely to experience pain. Findings associated with other bodily functions were assessed. Nausea and vomiting were reported in 20.5% of children. Twenty-six children (18%) had a fever. Thirty-nine (50.0%) parents reported that their children had problems eating.
Conclusion: Post-operative discomfort was more with 4 or more extraction done under DRGA and that nasal bleeding was noted a uncommon post-operative symptom.
PMCID: PMC4121698  PMID: 25097517
General anesthesia; Dental care for children; Dental caries; Extraction
2.  An unusual foreign body as cause of chronic sinusitis: a case report 
The presence of a foreign body in the nose is a relatively uncommon occurrence. Many unusual foreign bodies in the nose have been reported in the literature, but no case of a nasal packing occurring as a foreign body in the nasal cavity for a prolonged time has been found.
Case presentation
We describe a unique case of the largest foreign body left in situ in the nasal cavity for over 10 years. Our patient was a 71-year-old Caucasian man with diabetes. Because of this, he was at high risk of developing complications from the foreign body and the chronic sinusitis. Amazingly, though, the foreign body had not caused any symptoms on our patient for many years, except for nasal discharge during the last few years. To the best of our knowledge, this is the first case in the literature of such a large intra-nasal foreign body described in an adult without mental illness and without trauma that remained in situ for such a long time.
Undoubtedly, even illnesses with no complications could prove difficult for clinicians to diagnose. Clinicians should recognize the underlying causes that are responsible for the symptoms of chronic sinusitis and a unilateral nasal discharge should be assumed to be caused by an intra-nasal foreign body until proven otherwise.
PMCID: PMC2882928  PMID: 20504350
3.  Foreign Body in Root Canals of Two Adjacent Deciduous Molars: A Case Report 
Children often tend to have the habit of inserting foreign objects in the oral cavity unknowingly for relief of dental pain. Sometimes, children do not reveal to their parents due to fear. These foreign objects may act as a potent source of infection and painful condition. The discovery of foreign bodies in the teeth is a special situation, which is often diagnosed accidentally. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, location of the foreign body and the difficulty involved in its retrieval. Here is a case report, where foreign object was accidentally lodged in the carious deciduous molars by a child.
How to cite this article: Dhull KS, Acharya S, Ray P, Dhull RS. Foreign Body in Root Canals of Two Adjacent Deciduous Molars: A Case Report. Int J Clin Pediatr Dent 2013;6(1):38-39.
PMCID: PMC4034636  PMID: 25206186
Foreign body; Deciduous molars; Root canals
4.  Unusual Foreign Bodies in the Orofacial Region 
Case Reports in Dentistry  2012;2012:191873.
Foreign bodies may be deposited in the oral cavity either by traumatic injury or iatrogenically. Among the commonly encountered iatrogenic foreign bodies are restorative materials like amalgam, obturation materials, broken instruments, needles, and so forth. The discovery of foreign bodies in the teeth is a special situation, which is often diagnosed accidentally. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, location of the foreign body, and the difficulty involved in its retrieval. It is more common to find this situation in children as it is a well-known fact that children often tend to have the habit of placing foreign objects in the mouth. Sometimes the foreign objects get stuck in the root canals of the teeth, which the children do not reveal to their parents due to fear. These foreign objects may act as a potential source of infection and may later lead to a painful condition. This paper discusses the presence of unusual foreign bodies—a tip of the metallic compass, stapler pin, copper strip, and a broken sewing needle impregnated in the gingiva and their management.
PMCID: PMC3399346  PMID: 22830058
5.  The ‘Parent's Kiss’: An Effective Way to Remove Paediatric Nasal Foreign Bodies 
The objectives of this study were to: (i) evaluate the effectiveness of ‘parent's kiss’ as a technique for removal of nasal foreign bodies in children; and (ii) determine whether this technique reduces the number of children requiring general anaesthesia for their removal.
This was a prospective observational study in the accident and emergency and ENT departments at Luton and Dunstable Hospital. The participants were 31 children with nasal foreign bodies, under the age of 5 years, presenting via the acute services over a 6-month period. The primary outcome measured was successful removal of nasal foreign body with the ‘parent's kiss’ technique. Secondary outcome was reduction in the number of general anaesthetics following introduction of the technique.
The technique was successful in 20 out of the 31 children (64.5%) in the study group. Only one patient required general anaesthesia for removal of nasal foreign body (3%). This compares with a rate of 32.5% requiring removal under general anaesthetic in the preceding 6-month period. The ‘parent's kiss’, when not successful, seemed to improve the visibility of the foreign body making their subsequent removal easier.
The ‘parent's kiss’ is an effective technique. It is non-traumatic, both physically and emotionally, for the child subjected to it. We advocate that it should be used routinely as a first line of management in children with a nasal foreign body in the primary care setting.
PMCID: PMC2645753  PMID: 18634742
Foreign; Body; Nose; Parent's kiss
6.  Foreign body in the nasopharynx of a child 
Introduction of foreign body into the nasal cavity of the children by themselves is very common, but lodgment of foreign body in the nasopharyux following introduction through mouth is unusual. Here a case is presented from the Otorhinolaryngology department of S.S.K.M. Hospital, Kolkata, where a child was brought by their parents with history of introduction of a metallic foreign body in the mouth of the child by himself and this foreign body was found to be lodged in the nasopharynx of the child. The foreign body was removed orally in the out patient department. The patient returned home without any complication.
PMCID: PMC3451339  PMID: 23120182
Laryngoscope; Luc’s forceps; Nasopharynx
7.  Ventilation via Cut Nasotracheal Tube During General Anesthesia 
Anesthesia Progress  2013;60(1):11-14.
Many patients with disabilities need recurrent dental treatment under general anesthesia because of high caries prevalence and the nature of dental treatment. We evaluated the use of a nasal device as a possible substitute for flexible laryngeal mask airway to reduce the risk of unexpected failure accompanying intubation; we succeeded in ventilating the lungs with a cut nasotracheal tube (CNT) with its tip placed in the pharynx. We hypothesized that this technique would be useful during dental treatment under general anesthesia and investigated its usefulness as part of a minimally invasive technique. A prospective study was designed using general anesthesia in 37 dental patients with disabilities such as intellectual impairment, autism, and cerebral palsy. CNT ventilation was compared with mask ventilation with the patient in 3 positions: the neck in flexion, horizontal position, and in extension. The effect of mouth gags was also recorded during CNT ventilation. The percentages of cases with effective ventilation were similar for the 2 techniques in the neck extension and horizontal positions (89.2–97.3%). However, CNT ventilation was significantly more effective than mask ventilation in the neck flexion position (94.6 vs 45.9%; P < .0001). Mouth gags slightly reduced the rate of effective ventilation in the neck flexion position. Most dental treatments involving minor oral surgeries were performed using mouth gags during CNT ventilation. CNT ventilation was shown to be superior to mask ventilation and is useful during dental treatment under general anesthesia.
PMCID: PMC3601724  PMID: 23506278
General anesthesia; Cut nasotracheal tube.
8.  Novel Approach to Rectal Foreign Body Extraction 
A SILS port may allow minimally invasive extraction of a rectal foreign body not amenable to simple manual extraction.
The impacted rectal foreign body often poses a management challenge. Ideally, such objects are removed in the emergency department utilizing a combination of local anesthesia, sedation, minimal instrumentation, and manual extraction. In some instances, simple manual extraction is unsuccessful and general anesthesia may be necessary. We describe a novel approach to retrieval and removal of a rectal foreign body utilizing a SILS port.
Case Description:
A 31-y-old male presented to the emergency department approximately 12 h after transanal insertion of a plastic cigar case. Abdominal examination revealed no evidence of peritonitis. On rectal examination, the tip of the cigar case was palpable. The foreign body, however, was unable to be removed manually in the emergency department. In the operating room, with the patient under general anesthesia, multiple attempts to remove the object were unsuccessful. A SILS port was inserted transanally. The rectum was then insufflated manually by attaching the diaphragm of the rigid sigmoidoscope to the SILS insufflation port. A 5-mm 0-degree laparoscope was placed through the SILS port. An atraumatic laparoscopic grasper was then placed through the port and used to grasp the visible end of the cigar case. The rectal foreign body was removed expeditiously. Direct visualization of the rectum revealed no evidence of mucosal injury. The patient was discharged home shortly after the procedure.
The SILS port allows minimally invasive extraction of rectal foreign bodies not amenable to simple manual extraction. It provides excellent visualization and eliminates the morbidity inherent in more invasive and traditional methods of retrieval.
PMCID: PMC3771807  PMID: 23925034
Minimally invasive; Sigmoidoscopy; Foreign body; Rectum
9.  Study of Foreign-Body Extraction from the Upper Third of the Esophagus in Children 
Iranian Journal of Pediatrics  2014;24(2):214-218.
Throat-operating forceps are an auxiliary tool used for tracheal intubation during general anesthesia as well as for artificial respiration and during airway emergency when tracheal intubation is necessary. These forceps are a commonly used tool particularly for introducing the distal end of the endotracheal catheter into the airway at the epiglottis during difficult airway intubation and nasotracheal intubation. Throat-operating forceps have a required radian for operation at the intraoral epiglottis and have different types (large, medium, and small) that are suitable for patients of different ages. These tools have flexible forceps clamps and target-like, smooth distal ends that do not injure mucous membranes. Given these advantages, throat-operating forceps are used for pediatric endoesophageal foreign-body removal.
Case Presentation
Pediatric patients were anesthetized using different methods according to their age. A total of 15 patients five years to nine years of age were recruited. Foreign bodies were successfully removed without any complications.
Tracheal intubation forceps successfully removes esophageal foreign bodies in children because of the distinct shape of the forceps. The method is simple, feasible, and safe.
PMCID: PMC4268843  PMID: 25535542
Foreign Body; Esophagus; Throat Operating Forceps
10.  The Rhinolith—A Possible Differential Diagnosis of a Unilateral Nasal Obstruction 
Case Reports in Medicine  2010;2010:845671.
Rhinoliths are mineralised foreign bodies in the nasal cavity that are a chance finding at anterior rhinoscopy. Undiscovered, they grow appreciably in size and can cause a foul-smelling nasal discharge and breathing problems. Giant nasal stones are now a very rare occurrence, since improved diagnostic techniques, such as endoscopic/microscopic rhinoscopy, now make it possible to identify foreign bodies at an early stage of development. We report the case of a 37-year-old patient who, at the age of 5-6 years, introduced a foreign body, probably a stone, into his right nasal cavity. On presentation, he complained of difficulty in breathing through the right nostril that had persisted for the last 10 years. For the past four years a strong fetid smell from the nose had been apparent to those in his vicinity. Under general anaesthesia, the stone was removed in toto from the right nasal cavity. The possible genesis of the rhinolith is discussed, our case compared with those described in the literature, and possible differential diagnoses are considered.
PMCID: PMC2892702  PMID: 20592993
11.  An unexpected ferromagnetic foreign body detected during emergency magnetic resonance imaging: a case report 
BMC Research Notes  2014;7(1):808.
Sedation or anesthesia is often necessary in pediatrics when magnetic resonance imaging is performed. This anesthesia outside of the operation room combines specific requirements and risks. Ferromagnetic foreign bodies are a clear contraindication for magnetic resonance imaging due to the high magnetic field within the scanner. However, insertion of various small objects in mouth, nose or external auditory is not uncommon in small children and often remains unnoticed until specific symptoms develop. Early warning sings like movement of the object or heat development are then concealed by sedation or anesthesia preventing a timely termination of the possibly hazardous procedure.
Case presentation
We present a case of a three year old Caucasian with an acute sinusitis due to unknown ferromagnetic foreign body in his nasal cavity. As soon as the suspicion was raised the procedure was aborted and the object that revealed to be a small button battery was successfully removed.
The potential of unwelcome side effects and effective safety strategies of magnetic resonance imaging are discussed as well as the complications arising from ingested batteries.
PMCID: PMC4252995  PMID: 25403316
Metallic foreign body; Magnetic resonance imaging; Anesthesia
12.  Warming Endotracheal Tube in Blind Nasotracheal Intubation throughout Maxillofacial Surgeries 
Introduction: Blind nasotracheal intubation is an intubation method without observation of glottis that is used when the orotracheal intubation is difficult or impossible. One of the methods to minimize trauma to the nasal cavity is to soften the endotracheal tube through warming. Our aim in this study was to evaluate endotracheal intubation using endotracheal tubes softened by hot water at 50 °C and to compare the patients in terms of success rate and complications.
Methods: 60 patients with ASA Class I and II scheduled to undergo elective jaw and mouth surgeries under general anesthesia were recruited.
Results: success rate for Blind nasotracheal intubation in the control group was 70% vs. 83.3% in the study group. Although the success rate in the study group was higher than the control group, this difference was not statistically significant. The most frequent position of nasotracheal intubation tube was tracheal followed by esophageal and anterior positions, respectively.
Conclusion:In conclusion, our study showed that using an endotracheal tube softened by warm water could reduce the incidence and severity of epistaxis during blind nasotracheal intubation; however it could not facilitate blind nasotracheal intubation.
PMCID: PMC3883537  PMID: 24404345
Blind Intubation; Warming; Endotracheal Tube; Oral and Maxillofacial Surgery; Anesthesia
13.  Impacted Laryngeal Foreign Body in a Child: A Diagnostic and Therapeutic Challenge 
Impacted laryngeal foreign body could lead to catastrophic consequences if appropriate diagnostic and therapeutic procedures are not promptly instituted. A case of 4-year-old child who presented with a 4-day history of probable ingestion or aspiration of a pen part and history of occasional noisy breathing on exertion and swallowing is reported. On examination, the child appeared asymptomatic on general examination. CT scan of larynx and chest revealed foreign body in the larynx. A conical plastic foreign body in the laryngotracheal junction was retrieved by rigid bronchoscopy. The asymptomatic nature of the foreign body was related to the presence of a lumen within the foreign body permitting ventilation and the inert nature of the material. The case demonstrates the importance of the history, CT scan in case of suspicion, and the need for urgent bronchoscopy with appropriate anesthetic technique.
PMCID: PMC3793463  PMID: 24116337
Foreign body; Larynx; Lumen; Trachea
14.  Efficacy and safety of the “mother’s kiss” technique: a systematic review of case reports and case series 
Foreign bodies lodged in the nasal cavity are a common problem in children, and their removal can be challenging. The published studies relating to the “mother’s kiss” all take the form of case reports and case series. We sought to assess the efficacy and safety of this technique.
We performed a comprehensive search of the Cochrane library, MEDLINE, CINAHL, Embase, AMED Complementary and Allied Medicine and the British Nursing Index for relevant articles. We restricted the results to only those studies involving humans. In addition, we checked the references of relevant studies to identify further possibly relevant studies. We also checked current controlled trials registers and the World Health Organization search portal. Our primary outcome measures were the successful extraction of the foreign object from the nasal cavity and any reported adverse effects. We assessed the included studies for factors that might predict the chance of success of the technique. We assessed the validity of each study using the Newcastle–Ottawa scale.
Eight relevant published articles met our inclusion criteria. The overall success rate for all of the case series was 59.9% (91/152). No adverse effects were reported.
Evidence from case reports and case series suggests that the mother’s kiss technique is a useful and safe first-line option for the removal of foreign bodies from the nasal cavities of children.
PMCID: PMC3503923  PMID: 23071371
15.  Endoscopic procedures for removal of foreign bodies of the aerodigestive tract: The Bugando Medical Centre experience 
Foreign bodies in the aerodigestive tract continue to be a common problem that contributes significantly to high morbidity and mortality worldwide. This study was conducted to describe our own experience with endoscopic procedures for removal of foreign bodies in the aerodigestive tract, in our local setting and compare with what is described in literature.
This was a prospective descriptive study which was conducted at Bugando Medical Centre between January 2008 and December 2009. Data were collected using a structured questionnaire and analyzed using SPSS computer software version 15.
A total of 98 patients were studied. Males outnumbered females by a ratio of 1.1:1. Patients aged 2 years and below were the majority (75.9%). The commonest type of foreign bodies in airways was groundnuts (72.7%) and in esophagus was coins (72.7%). The trachea (52.2%) was the most common site of foreign body's lodgment in the airways, whereas cricopharyngeal sphincter (68.5%) was the commonest site in the esophagus. Rigid endoscopy with forceps removal under general anesthesia was the main treatment modality performed in 87.8% of patients. The foreign bodies were successfully removed without complications in 90.8% of cases. Complication rate was 7.1% and bronchopneumonia was the most common complication accounting for 42.8% of cases. The mean duration of hospital stay was 3.4 days and mortality rate was 4.1%.
Aerodigestive tract foreign bodies continue to be a significant cause of childhood morbidity and mortality in our setting. Rigid endoscopic procedures under general anesthesia are the main treatment modalities performed. Prevention is highly recommended whereby parents should be educated to keep a close eye on their children and keep objects which can be foreign bodies away from children's reach.
PMCID: PMC3033844  PMID: 21255409
16.  Dislocated dental bridge covering the larynx: usefulness of tracheal tube guides under video-assisted laryngoscopy for induction of general anesthesia, thus avoiding tracheostomy 
Head & Face Medicine  2014;10:23.
To describe a case with dislodgement of dental bridge with clasps covering the vocal cords, in a patient who was successfully intubated using tube exchanger under video-assisted laryngoscopy.
Study design, methods
Clinical case record with a video clip.
University hospital.
Case presentation
A 83-year-old woman presented with dislodgement of her dental bridge whilst eating. Laryngoscopy revealed a foreign body almost entirely covering the vocal cords, with the clasps of the dislodged partial denture piercing the pharyngeal wall. Before induction of general anesthesia, a tracheal tube introducer combined with video-assisted laryngoscopy was introduced into the trachea in the awake condition, followed by successful endotracheal intubation. Thereafter, the dislodged denture was extracted via the oral cavity.
Tracheal tube introducers combined with video-assisted laryngoscopy appear to be useful for airway management, decreasing the number of avoidable tracheostomies performed.
PMCID: PMC4059481  PMID: 24919781
Dental bridge; Foreign body; Dislodgement; Tube introducer; Tracheostomy
17.  Management of rectal foreign bodies 
Entrapped anorectal foreign bodies are being encountered more frequently in clinical practice. Although entrapped foreign bodies are most often related to sexual behavior, they can also result from ingestion or sexual assault.
Between 1999 and 2009, 15 patients with foreign bodies in the rectum were diagnosed and treated, at Izmir Training and Research Hospital, in Izmir. Information regarding the foreign body, clinical presentation, treatment strategies, and outcomes were documented. We retrospectively reviewed the medical records of these unusual patients.
All patients were males, and their mean age was 48 years (range, 33–68 years). The objects in the rectum of these 15 patients were an impulse body spray can (4 patients), a bottle (4 patients), a dildo (2 patient), an eggplant (1 patient), a brush (1 patient), a tea glass (1 patient), a ball point pen (1 patient) and a wishbone (1 patient, after oral ingestion). Twelve objects were removed transanally by anal dilatation under general anesthesia. Three patients required laparotomy. Routine rectosigmoidoscopic examination was performed after removal. One patient had perforation of the rectosigmoid and 4 had lacerations of the mucosa. None of the patients died.
Foreign bodies in the rectum should be managed in a well-organized manner. The diagnosis is confirmed by plain abdominal radiographs and rectal examination. Manual extraction without anaesthesia is only possible for very low-lying objects. Patients with high- lying foreign bodies generally require general anaesthesia to achieve complete relaxation of the anal sphincters to facilitate extraction. Open surgery should be reserved only for patients with perforation, peritonitis, or impaction of the foreign body.
PMCID: PMC3601006  PMID: 23497492
Foreign body; Rectum; Anorectal trauma
18.  Endoscopic retrieval of an 18-cm long chopstick embedded for ten months post-automutilation in the esophagus of a patient with psychosis 
Foreign body ingestion is an emergency or acute situation that commonly occurs in children or adults and involves the ingestion of one or more objects. Moreover, once the discovery of swallowed foreign bodies has been made, families are typically very anxious to have the patient see a doctor. If the foreign object becomes embedded in the digestive tract, it must be removed; in emergencies, this is done by endoscopy or surgery. This case report presents the successful endoscopic retrieval of a chopstick with both sides embedded 4 cm into the esophageal wall for > 10 mo in a male patient following automutilation in an attempt to be released from a psychiatric hospital. Hot hemostatic forceps were used to open the distal esophageal mucosa in which the chopstick was embedded. The procedure was performed under intravenous general anesthesia and took approximately 7 h.
PMCID: PMC4163728  PMID: 25228948
Foreign body; Esophagus; Endoscopy; Chopstick; Gastroscope; Hot hemostatic forceps
19.  Liver abscess secondary to a broken needle migration- A case report 
BMC Surgery  2003;3:8.
Perforation of gut by sharp metallic objects is rare and rarer still is their migration to sites like liver. The symptoms may be non-specific and the discovery of foreign body may come as a radiological surprise to the unsuspecting clinician since the history of ingestion is difficult to obtain.
Case report
A unique case of a broken sewing needle in the liver causing a hepatic abscess and detected as a radiological surprise is presented. The patient had received off and on treatment for pyrexia for the past one year at a remote primary health center. Exploratory laparotomy along with drainage of abscess and retrieval of foreign body relieved the patient of his symptoms and nearly one-year follow up reveals a satisfactory recovery.
It is very rare for an ingested foreign body to lodge in the liver and present as a liver abscess. An ultrasound and a high clinical suspicion index is the only way to diagnose these unusual presentations of migrating foreign bodies. The management is retrieval of the foreign body either by open surgery or by percutaneous transhepatic approach but since adequate drainage of the abscess and ruling out of a fistulous communication between the gut and the liver is mandatory, open surgery is preferred.
PMCID: PMC239862  PMID: 14531934
Hepatic abscess; Foreign body migration
20.  Foreign Body Obstruction Preventing Blind Nasal Intubation 
Anesthesia Progress  2006;53(2):49-52.
A healthy young male patient was scheduled for dental care under nasotracheal intubated general anesthesia. The presence of a plastic calculator key complicated the intubation. This case report describes the event and reviews some possible techniques for coping with an airway that becomes obstructed by a foreign object.
PMCID: PMC1614215  PMID: 16863390
Foreign body obstruction; Intubation
21.  Tracheo-Bronchial Foreign Body Aspiration in Children: A One Year Descriptive Study 
The aim of this work was to study the clinical presentation of tracheo-bronchial foreign body aspiration in children for its early diagnosis. This article attempts to address the potential hazards of foreign body inhalation in children and its subsequent management by rigid bronchoscopy. This study was conducted in Department of Otorhinolaryngology, K.L.E.S Dr. Prabhakar Kore Hospital, Belgaum, for a period of 1 year. Children less than 16 years of age with history suggestive or suspicious of foreign body aspiration were screened clinically and radiologically and those patients with high index of suspicion of foreign body were included in the study. All patients were subjected to rigid bronchoscopy under general anaesthesia and the results were analyzed. This study comprises of 29 patients with suspected foreign body aspiration. On rigid bronchoscopy, foreign body was found and successfully removed in 22 patients. Highest incidence was seen in boys between 1 and 2 years age. History of foreign body aspiration was absent in most cases and children presented with combination of symptoms. Obstructive emphysema was commonest chest X-ray finding. There was no significant difference in the site of foreign body aspiration on the right and left bronchus and commonest foreign bodies were vegetative type. Complication rates in this study were low as compared to previous studies. Tracheo-bronchial foreign body aspiration is very common in children. Foreign body aspiration usually presents as an un-witnessed episode and a high index of suspicion by the surgeon, even in absence of a positive history is necessary to prevent morbidity and mortality due to delayed or misdiagnosis. Foreign body aspiration is an emergency and should be removed by rigid bronchoscopy at the earliest to prevent complications.
PMCID: PMC3918306  PMID: 24533380
Foreign bodies; Tracheo-bronchial tree; Rigid bronchoscopy
22.  Epidemiology and Management of Foreign Bodies in the Hand: Pakistani Perspective 
Penetrating and impalement injuries of the hand and fingers are one of the commonest presentations at the hospital’s emergency rooms. This study assessed the characteristics of patients who suffered foreign body injuries to the hands and documented the pattern of diagnosis and management at a specialist plastic surgical facility.
The study was conducted at the Department of Plastic and Reconstructive Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad over a period of six years
(i.e. from September 1, 2007 to July 31, 2013). All adult patients (37 subjects) of either gender who were managed for hand foreign bodies during the study period were included by convenience sampling technique. The demographic profile of the patients, cause of injury, type of foreign body, occupation of the patient, diagnostic yield of plain x-rays, type of procedure undertaken for retrieval of foreign body, and complications were all recorded on a form. A follow-up of three months was done.
Eighteen (48.64%) were males while 51.35% (n=19) were female. The mean age was 26.78±9.94 years. The commonest sufferers were housewives 29.72% (n=11). Majority of patients (n=16; 43.24%) presented on day 3 (i.e. >48-72 hours), among the injury causing mechanisms, the commonest were accidents with sewing machines 45.94% (n=17) and sewing machine needles 45.94% (n=17) were the commonest foreign bodies observed. The plain x-ray hands reveled the diagnosis in all patients except those with wooden foreign bodies (n=3; 8.10%). All patients had successful surgical exploration and retrieval of the foreign bodies under local anesthesia and tourniquet control. In two cases, image intensifier was employed to locate the foreign bodies per-operatively. Wound infection was found in 0.8% (n=4) patients, all of whom were managed successfully with oral antibiotics. None of patients had hospitalization. All patients were fine at 3 months follow up.
Surgical exploration and careful retrieval under local anesthesia and tourniquet control suffice as the definitive treatment. Rarely intra-operative image intensifier is needed to locate foreign bodies per-operatively.
PMCID: PMC4236977  PMID: 25489518
Foreign body; Hand; Penetrating; Diagnosis
23.  The Management of Foreign Bodies in the Pharynx and Oesophagus Using Transnasal Flexible Laryngooesophagoscopy (TNFLO) 
We describe our experience of the diagnosis and removal of foreign bodies from the pharynx and oesophagus using transnasal flexible laryngo-oesophagoscopy (TNFLO) under local analgesic. The advantages of this novel instrumentation and technique are discussed.
Patients were examined with a Pentax 80K Series Digital Video Endoscope after local analgesia. The instrument was passed transnasally examining the oro- and hypopharynx, and then passed into the oesophagus. The presence, type and site of a foreign body could then be established. If a foreign body was detected, such as fish bone, it was extracted using flexible grabbing forceps passed down the instrument channel and delivered through the nasal or oral cavity. The object was then inspected to ensure removal in its entirety.
Five cases have been successfully managed using TNFLO.
TNFLO represents an improvement in the diagnosis and subsequent treatment of a selected group of foreign bodies as compared with established methodologies.
PMCID: PMC2216707  PMID: 18201491
Flexible transnasal laryngo-oesophagoscopy; TNFLO; Foreign body
24.  Button Battery Foreign Bodies in Children: Hazards, Management, and Recommendations 
BioMed Research International  2013;2013:846091.
Objective. The demand and usage of button batteries have risen. They are frequently inadvertently placed by children in their ears or noses and occasionally are swallowed and lodged along the upper aerodigestive tract. The purpose of this work is to study the different presentations of button battery foreign bodies and present our experience in the diagnosis and management of this hazardous problem in children. Patients and Methods. This study included 13 patients. The diagnostic protocol was comprised of a thorough history, head and neck physical examination, and appropriate radiographic evaluation. The button batteries were emergently extracted under general anesthesia. Results. The average follow-up period was 4.3 months. Five patients had a nasal button battery. Four patients had an esophageal button battery. Three patients had a button battery in the stomach. One patient had a button battery impacted in the left external ear canal. Apart from a nasal septal perforation and a tympanic membrane perforation, no major complications were detected. Conclusion. Early detection is the key in the management of button battery foreign bodies. They have a distinctive appearance on radiography, and its prompt removal is mandatory, especially for batteries lodged in the esophagus. Physicians must recognize the hazardous potential and serious implications of such an accident. There is a need for more public education about this serious problem.
PMCID: PMC3725977  PMID: 23936851
25.  Endodontic management of an unusual foreign body in a maxillary central incisor 
The discovery of foreign bodies in the teeth is often diagnosed accidentally. It is commonly seen in children. These foreign objects may act as a potential source of infection and may later lead to a painful condition. Detailed case history, clinical and radiographic examinations are necessary to come to a conclusion about the nature, size, and location of the foreign body, and the difficulty involved in its retrieval. This paper discusses the types of foreign objects found in and around the teeth and reports an unusual case of a stapler pin in the root canal of a tooth, its retrieval, and associated management of the involved teeth.
PMCID: PMC3778635  PMID: 24082582
Foreign bodies; source of infection; stapler pins in teeth

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