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.
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.
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.
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.
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.
Laryngoscope; Luc’s forceps; Nasopharynx
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.
Foreign body; Larynx; Lumen; Trachea
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.
General anesthesia; Cut nasotracheal tube.
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.
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.
Minimally invasive; Sigmoidoscopy; Foreign body; Rectum
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.
Foreign body obstruction; Intubation
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.
PATIENTS AND METHODS
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.
Foreign; Body; Nose; Parent's kiss
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 AND METHODS
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.
Flexible transnasal laryngo-oesophagoscopy; TNFLO; Foreign body
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.
Blind Intubation; Warming; Endotracheal Tube; Oral and Maxillofacial Surgery; Anesthesia
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.
A case report showing the removal of a supernumerary tooth from the nasal cavity by means of an endoscopic approach is presented.
Materials and methods
A 9-year-old healthy child presented to our department because of the right central incisor which appeared clinically rotated. The observation of orthopantomography revealed the presence of a supernumerary tooth in the anterior maxilla with the crown positioned towards the nasal floor. The maxillary CT demonstrated a quite close relationship of the tooth with the nasal cavity, so a nasal approach was planned.
Under general anesthesia the supernumerary tooth was removed by means of an endoscopic approach from a nostril. During the extraction the adjacent structures were unharmed. The postoperative course was uneventful.
This case report suggests that in case of supernumerary teeth positioned close to the nasal cavity, trans-nasal endoscopy may represent a valid alternative to more demolishing traditional surgery.
ectopic tooth; supernumerary; nasal floor; extraction; transnasal endoscopy
Objective. The presence of an upper airway foreign body is an emergent, potentially life-threatening situation that requires careful but rapid evaluation and management. Organic or nonorganic material may typically be found in the pyriform sinuses or tongue base or may be aspirated directly into the tracheobronchial tree. We present here an unusual case report of a patient who accidentally ingested a plastic bread clip that was lodged in his subglottis for 15 months and report successful removal in the office under local anesthesia. Methods. Mucosal anesthesia was achieved with inhaled 4% lidocaine spray. Flexible laryngoscopic removal of the foreign body was then successfully accomplished. Results. The patient's symptoms resolved completely following removal, with no sequelae. Conclusions. Office removal of airway foreign bodies is feasible and can be safely done with adequate topical anesthesia, but great caution and emergency planning must be exercised.
Nasal bleeding is a frequent problem for patients receiving anticoagulant agents.
Most cases are successfully managed with anterior or posterior nasal packing.
However, the complications of nasal packing should be always considered. We
report the case of a 78-year-old man with Alzheimer’s disease who was
treated for anterior epistaxis with anterior nasal packing using three pieces of
antibiotic-soaked gauze. Two days later, the patient was admitted to the
emergency department in respiratory distress. A chest x-ray demonstrated
atelectasis of the right lung. During an examination of the nasal cavities, the
nasal packing was removed, and one of the gauze pieces was missing. The patient
underwent rigid bronchoscopy, and the missing gauze was found to be obstructing
the right main bronchus. The patient’s respiratory function improved
considerably after removal of the foreign body. It is assumed that gauze packs
should be used with caution in patients with an impaired level of consciousness
and neurodegenerative diseases.
epistaxis; nasal packing; aspiration; Alzheimer’s disease; cough reflex
We describe an unusual case of a foreign body penetrating the skull base and lodging in the posterior fossa. A 38-year-old woman fell onto a chopstick while eating, causing it to impact into her mouth. The chopstick penetrated the oropharynx and the occipital bone via the jugular foramen to enter the posterior fossa intracranially, piercing the tentorium cerebelli and leaving a fractured tip in the occipital lobe. Three-dimensional reconstructive computed tomographic scans were obtained to view the trajectory and position of the chopstick. Reconstructed angiography revealed the proximity of the carotid artery and the jugular vessels to the foreign object. Safe access to the chopstick was via an occipital craniotomy to retrieve the distal portion and an ipsiplateral retrosigmoid craniectomy to remove the proximal end. Provision was made to gain proximal control of all major nearby vessels in the event of any hemorrhage. Trauma causing penetration of a foreign body into the posterior fossa of the skull is rare due to its surrounding thick bone. Appropriate preoperative planning, including 3-D computed tomographic images and angiograms, are integral in the surgical approach for the safe removal of such objects.
Chopstick; penetrating trauma; posterior fossa; skull base
Maxillofacial trauma presents a complex problem due to the disruption of normal anatomy. In such cases, we anticipate a difficult oral intubation that may hinder intraoperative IMF. Nasal and skull base fractures do not advocate use of nasotracheal intubation. Hence, other anesthetic techniques should be considered in management of maxillofacial trauma patients with occlusal derangement and nasal deformity. This study evaluates the indications and outcomes of anesthetic management by retromolar, nasal, submental intubation and tracheostomy.
Of the 49 maxillofacial trauma cases reviewed, that required intraoperative IMF, 32 underwent nasal intubation, 9 patients had tracheostomy, 5 patients utilized submental approach and 3 underwent retromolar intubation.
Among patients who underwent nasal intubation, eight cases needed fiberoptic assistance. In retromolar approach, though no complication was encountered, constant monitoring was mandatory to avoid risk of tube displacement. Consequently, submental intubation required a surgical procedure which could result in a cosmetically acceptable scar. Though invasive, tracheostomy has its benefits for long term ventilation.
Intubation of any form performed in a maxillofacial trauma patient is complex and requires both sound judgement and considerable experience.
Maxillofacial trauma; Nasal intubation; Submental intubation; Retromolar technique; Tracheostomy; Intermaxillary fixation
Most foreign bodies pass through the gastrointestinal tract uneventfully. The majority of the reported literature describes the management of ingested blunt objects. However, ingestion of sharp objects can still occur with a higher rate of perforation corresponding to treatment dilemmas.
We report the conservative management of an inadvertently ingested sharp foreign body during a routine dental procedure and describe a management strategy for the treatment of both blunt and sharp foreign bodies.
Urgent endoscopic assessment and retrieval is indicated when there is a history of a recently ingested sharp foreign body or if clinical suspicion suggests that the object is located within the oesophagus. Conservative management is advocated if the object has passed through the pylorus with serial clinical assessments including daily radiographs. Surgical intervention is warranted in the presence of obstruction, perforation or peritonitis.
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.
Foreign bodies; source of infection; stapler pins in teeth
Aspiration of a foreign body into the respiratory tract is a common and serious problem in childhood but is rare in adults. Two interesting cases in which the diagnosis of foreign body in the larynx was not suspected preoperatively are being reported. A three and half year old female child was diagnosed as a case of bronchitis and was later found to have a metallic spring in the supraglottic region which was removed by direct laryngoscopy under general anesthesia. The other patient, a 32-year-old male, was diagnosed to have a fibrous lesion in the larynx one year previously, and on laryngoscopy a vegetable, spiculated foreign body was found after excising the fibrous lesion on the left false cord. Both the cases are symptom free 18 months after endoscopy.
Unusual foreign body; Laryngeal foreign Bodies
We report a case of a toothbrush head lodged into the nasal cavity, which required an external rhinoplasty for retrieval. A review of the literature on management strategies in case of nasal foreign bodies is presented.
Foreign body; open rhinoplasty; nasal cavity
Internal nasal dilators are widely used but have not been reported to cause severe symptoms. We describe a case in which a male adult had accidentally, during sleep, inhaled a nasal dilator into his right nasal cavity, and we review the relevant literature. A PubMed search was performed of nasal dilators, especially of the internal types, including “Nasaline Snooze'” (ENTPro, Stockholm, Sweden). A foreign body in adults may be an inhaled nasal dilator. It may be overlooked on computed tomography scans, and thorough inspection of the nose is diagnostic.
Adult; computed tomography; foreign body; head ache; nasal dilator; nasal obstruction; sinusitis
Development of a cystic mass on the nasal dorsum is a very rare complication of aesthetic rhinoplasty. Most reported cases are of mucous cyst and entrapment of the nasal mucosa in the subcutaneous space due to traumatic surgical technique has been suggested as a presumptive pathogenesis. Here, we report a case of dorsal nasal cyst that had a different pathogenesis for cyst formation. A 58-yr-old woman developed a large cystic mass on the nasal radix 30 yr after augmentation rhinoplasty with silicone material. The mass was removed via a direct open approach and the pathology findings revealed a foreign body inclusion cyst associated with silicone. Successful nasal reconstruction was performed with autologous cartilages. Discussion and a brief review of the literature will be focused on the pathophysiology of and treatment options for a postrhinoplasty dorsal cyst.
Rhinoplasty; Inclusion; Cysts; Radix; Silicones; Complications
OBJECTIVE: A pilot study to assess whether modern metal detectors can reduce unnecessary radiation in searching for ingested metallic foreign bodies. METHODS: Over a one year period, 20 children presenting to an accident and emergency department with suspected metallic foreign body ingestion were studied. Using an Adams Electronics AD15 metal detector, the radiographer recorded the location of metallic foreign bodies on a pictorial representation of neck, chest, and abdomen. The child then had plain radiographs of abdomen, chest, and neck in sequential order until the foreign body was located. RESULTS: In seven cases neither metal detector nor radiography revealed a foreign body (true negatives). In the remaining 13 cases where metal detection was positive, subsequent radiography or faecal search was also positive (true positives). The 13 foreign bodies were coins (8), gold ring (1), ball bearing (1), screw (1), staple (1), and washer (1). All were in the stomach or proximal small bowel on radiography except for one coin in the right iliac fossa. CONCLUSIONS: The detector can demonstrate ingested metallic foreign bodies reliably in children, thereby reducing unnecessary irradiation.
Two infants in different nurseries were found with cardiopulmonary arrest. Cardiopulmonary resuscitation was undertaken immediately in both cases, but was unsuccessful. The cause of death in both infants was diagnosed as sudden unexpected death, probably sudden infant death syndrome, at postmortem investigations. Microscopic examination at autopsy showed the presence of starch granules in the lungs. These were probably introduced during tracheal or nasotracheal intubation for cardiopulmonary resuscitation from gloves sterilized with powdered cornstarch. In both cases cellular staining of foreign bodies was weak and there were few starch granules within macrophages. Our findings suggest that the detection of cornstarch in the lungs can be an artifact arising from surgical gloves used in resuscitation. This artifact may easily occur in infants because of their immature lungs and short respiratory tract. Non-powdered gloves should be worn instead of powdered gloves during tracheal intubation, especially in infants.
Postmortem; Lungs; Starch; Autopsy; Artifact