Foreign Body

Unusual nasopharyngeal foreign body: A hooked iron rod

July 5, 2012     Evelyne S. Diom, MBChB; Raymond Diouf, MBChB; El Hadji Malick Diop, MBChB
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Abstract

Foreign bodies lodged in the nasopharynx are rare. We report a case of an unusual foreign body in the nasopharynx: a hooked iron rod. The patient was a 5-year-old girl. The foreign body had to be removed under general anesthesia. To the best of our knowledge, there has been no similar published report of a hooked iron rod in the nasopharynx.

Ectopic intranasal tooth: An unusual cause of epistaxis in a child

June 4, 2012     Roshan K. Verma, MS, DNB, MNAMS; Jaimanti Bakshi, MS, DNB; Naresh K. Panda, MS, MNAMS, FRCS
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Abstract

Nasal bleeding is a common disorder in children that is frequently caused by irritation in the Kiesselbach plexus (also known as Little’s area). Other common underlying causes include local inflammatory diseases of the nose, infections, vascular malformations, and trauma. We report here a rare case of an ectopic tooth in the nasal cavity as the cause of recurrent epistaxis in a 3.5-year-old child. The clinical presentation, investigations, and management are discussed.

Management of foreign bodies in the ear: A retrospective review of 123 cases in Nigeria

November 22, 2011     Toye G. Olajide, MBBS, FWACS, Foluwasayo E. Ologe, MBBS, FWACS, and Oluwabukola O. Arigbede, MBBS
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Abstract

Foreign bodies in the ear are relatively common in emergency medicine. However, attempts at removal made outside the healthcare setting by untrained persons can result in complications of varying degrees. We conducted a 3-year retrospective review of 123 cases of aural foreign bodies at our hospital in Nigeria. Our patient population was made up of 80 males and 43 females, aged 2 to 67 years (mean: 13.2); almost three-fourths of these patients were aged 15 years or younger. Only 40 of them (32.5%) presented to an otolaryngologist within 12 hours of foreign-body insertion. A total of 30 patients (24.4%) had initially undergone removal attempts by a non-otolaryngologist prior to receiving trained ENT care, and 23 of them experienced a total of 41 complications: 17 cases of canal abrasion, laceration, and/or bleeding, 8 cases of otitis externa, 6 cases of tympanic membrane perforation, 5 cases of impaired hearing, 3 cases of chronic suppurative otitis media, and 2 cases of middle ear involvement. Of the 93 patients who were seen by an otolaryngologist initially, only 6 (6.5%) developed a complication: 4 cases of canal abrasion, laceration, and/or bleeding and 2 cases of otitis externa. The difference in overall complication rates between patients treated by otolaryngologists and non-otolaryngologists was statistically significant (p < 0.001). We conclude that attempts at removal by non-otolaryngologists can result in a high incidence of preventable complications.

Dual laryngeal foreign body

November 22, 2011     Omar Rahmat, MBBS, MS(Orl) and Narayanan Prepageran, FRCS
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An unusual case of a ballpoint pen migrating into the parapharyngeal space and middle mediastinum

November 22, 2011     Grace H. Kim, MD, Eugene P. Snissarenko, MD, and Paul D. Kim, MD
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Abstract

Foreign bodies that penetrate the esophagus and migrate extraluminally are unusual. If they are left untreated, serious complications arise from mediastinitis, and damage to the major structures in the neck can occur. We report a case of a patient who presented with chest pain on inspiration that was found to be caused by a foreign body in the parapharyngeal space and middle mediastinum. Preoperative imaging is critical in obtaining landmarks for safe surgical exploration and is essential to the successful management of penetrating and migrating foreign bodies. This case highlights the importance of localizing the foreign body preoperatively to aid in its surgical removal via a transcervical approach.

An unusual presentation of an asymptomatic neck mass

August 15, 2011     Rapahel Nach, MD, Lorraine M. Smith, MD, MPH, and Hootan Zandifar, MD
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Ballpoint pen ingestion in a 2-year-old child

July 13, 2011     Ana├»s Rameau, MD, CM, MSc, Sumeet M. Anand, MD, and Lily H.P. Nguyen, MD, CM, MSc, FRCS(C)
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Abstract

A 2-year-old girl ingested a ballpoint pen, which was found on chest x-ray to have lodged in the lower esophagus and stomach. The pen, which measured nearly 15 cm in length, was removed via rigid esophagoscopy without complication. To the best of our knowledge, this is the longest nonflexible foreign body ingested by a young child ever reported in the English-language literature. We describe the presentation of this case and the current guidelines for safety as enumerated in the Small Parts Regulations established by the U.S. Consumer Product Safety Commission

An unusual cause of foreign-body sensation in the throat: A displaced superior cornu of the thyroid cartilage

June 13, 2011     Emin Karaman, MD, Gkioukxel Saritzali, MD, Sait Albayram, MD, and Batuhan Kara, MD
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Abstract

Foreign-body sensation is a nonspecific symptom of aerodigestive tract diseases. We describe the case of a 42-year-old man who presented with a foreign-body sensation in the throat that was found to be caused by a displaced superior cornu of the thyroid cartilage. Such a displacement is not well known, but we believe that it may not be rare. These cases can be overlooked and misdiagnosed as chronic nonspecific pharyngitis or laryngopharyngeal reflux. However, a careful laryngoscopic examination by an otolaryngologist who considers the possibility of such a pathology may result in an accurate diagnosis, which might spare an affected patient from a lifelong pharmacotherapeutic regimen.

Fluoroscopic localization of a retained intranasal ballistic foreign body in an unexpected location

December 17, 2010     Charles Stewart III, MD, Christopher Le, MD, and Thomas Stewart, MD
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Abstract

Otolaryngologists are frequently asked to evaluate impacted nasal foreign bodies in children. Multiple techniques have been used for the removal of these objects. We describe what we believe is a previously unreported mechanism of nasal foreign-body impaction and the novel method we used to remove it. We also review the literature on retained ballistic nasal foreign bodies, including their management and complications.

Aspiration of radiolucent dentures in facial trauma: Case report

December 17, 2010     Jon B. Chadwell, MD, Joshua R. Mitchell, MD, Michael Donnino, MD, Charles Peterson, MD, Paul Guentert, MD, Cliff Arnold, BA, and Mark Walsh, MD
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Abstract

Foreign body aspiration is a serious problem that may lead to complications or even death. People who sustain major maxillofacial trauma can often damage their teeth or oral prostheses, and aspiration can occur. Detection of this type of aspiration can be difficult, especially in elderly people wearing dental appliances, since many dental prostheses are not radiopaque and the aspiration is not always recognized at the time of injury. We report a specific case of extensive maxillofacial trauma from a self-inflicted gunshot wound leading to aspiration of large, radiolucent denture fragments, delayed diagnosis, and complications. The possibility of denture fragment aspiration must always be part of the differential diagnosis in an elderly trauma patient presenting with dyspnea, hypoxia or, eventually, pneumonia. This is especially so when radiologic evaluation does not reveal a foreign body, since much dental prosthesis material is radiolucent. Delayed complications of radiolucent dental prosthesis aspiration could be avoided by the inclusion of some radiopaque material within the acrylic material of the prosthesis.

Intraglossal impaction of ingested fish bones: A case series

July 31, 2010     Shirish Johari, BSc, MBBS, DLO, DOHNS(Edin.), MRCSEd; and Kevin Yaw-Khian Chong, MBBS, FRCS(Ed), M Med(ORL-Singapore), FAMS(ORL), FAAOHNS(USA), EAONO, AINO(Italy)
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Abstract

Although foreign body ingestion and impaction in the pharynx or hypopharynx are quite commonly encountered at our institution, foreign body impaction in tongue tissue is rare. Six cases of foreign bodies embedded in the tongue were identified in a retrospective review spanning the years 1998 to 2007. All the foreign bodies were fish bones. Four of these patients required only tongue exploration to remove the bone; one required a partial glossectomy because of difficulties locating the bone; and one required incision and drainage of an intraglossal abscess that had developed, as well as a tracheostomy. All foreign bodies were successfully removed, with none of the patients experiencing altered sensation or problems with tongue mobility afterwards.

Retained pill capsule remnant in pyriform sinus

April 30, 2010     Ellen L. Baxter, DO and Adam D. Rubin, MD
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