International Journal of Pediatric Otorhinolaryngology Extra
Volume 3, Issue 1 , Pages 14-16, January 2008

Two rare case reports of nasopharyngeal foreign bodies—Bobbin and safety pin

  • Raman Wadhera

      Affiliations

    • Department of Otorhinolaryngology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
    • Corresponding Author InformationCorresponding author at: 19/9J, Medical Enclave, Pt. B.D. Sharma, PGIMS, Rohtak 124001, Haryana, India. Tel.: +91 1262 212860.
    • ,
  • S.P. Gulati

      Affiliations

    • Department of Otorhinolaryngology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
    • ,
  • Ajay Garg

      Affiliations

    • Department of Otorhinolaryngology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India
    • ,
  • Anju Ghai

      Affiliations

    • Department of Anesthesiology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India

Received 2 June 2007; received in revised form 19 August 2007; accepted 19 August 2007. published online 27 September 2007.

Article Outline

Summary 

Foreign bodies are rarely encountered in nasopharynx. Two cases of unusual foreign bodies in nasopharynx are reported. One patient had bobbin (metallic thread roller used in sewing machine) and other one presented with a safety pin. Diagnosis was confirmed by radiological examination. Bobbin was retrieved whereas safety pin was swallowed by the patient. The details are hereby discussed.

Keywords: Foreign bodies, Nasopharynx, Bobbin, Safety pin

 

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1. Introduction 

A considerable number of cases of foreign body ingestion and inhalation have been reported in the literature. Of these, nasopharyngeal foreign bodies are extremely rare. The route of entry is either anteriorly through the nose or posteriorly after vomiting or forceful coughing of an ingested or aspirated foreign body. This entity may also be encountered in patients with palatal defect or after penetrating trauma [1], [2]. Sometimes a foreign body in oral cavity of a child may be inadvertently pushed into the nasopharynx by digital manipulation in an attempt to bring it out by the attendants [3]. Occasionally, after surgery, packs may be left behind in nasopharynx. We are reporting two cases of unusual foreign bodies in nasopharynx.

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2. Case reports 


1.A 5-year-old male child was playing with a bobbin and he suddenly put it into his mouth. His parents tried to bring it out by putting their fingers in his mouth but could not succeed. Child was taken to a general practitioner and was advised chest and abdomen radiographs which did not reveal any foreign body. Then he was brought to our institute. He was anxious and his mouth was open with increased salivation but there was no respiratory distress or stridor. Throat examination revealed mucosal injury over right tonsil and bulging soft palate, but foreign body could not be visualized. X-ray nasopharynx lateral view revealed a bobbin in nasopharynx (Fig. 1). Under general anesthesia, patient was placed in supine position with head extended. A soft red rubber catheter was passed through each nostril and other end of the catheter was pulled out from the oropharynx in order to give traction to lift soft palate. Bobbin was retrieved with digital manipulation (Fig. 2).

2.A 3-year-old male child was brought with the history of putting a safety pin in his right nostril a day prior. Parents had tried to remove it at home but in vain. There was no difficulty in breathing or speech. On anterior rhinoscopy slight mucoid discharge was noticed in right nostril but safety pin could not be visualized. X-ray nose and nasopharynx lateral view revealed a safety pin lying in choana and nasopharynx (Fig. 3). It had probably been displaced posteriorly in an attempt to be removed at home. It was planned to remove it under general anesthesia. Patient was kept fasting for six hours. Nasal endoscopic examination did not reveal any foreign body in the nose or nasopharynx. It could not be located in throat also. It was then decided to take radiographs of chest and abdomen on the operation table itself, which showed safety pin lying in the gut. Procedure was abandoned and child was shifted to the ward for further observation. Safety pin was subsequently recovered in stools.

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3. Discussion 

A child with a witnessed history or in whom there is strong suspicion of foreign body ingestion, in particular a radio-opaque object, requires radiographic examination of the nose and nasopharynx if chest and abdominal films fail to demonstrate the object, as in our first patient. Probably, X-ray nasopharynx had not been advised by general practitioner keeping in mind the possibility of its passage into gastrointestinal tract. In case of non radio-opaque objects, endoscopic examination of the region should be considered [4].

Foreign body lodged in nasopharynx may cause serious and even fatal complications. It may descend and cause sudden airway obstruction or patient may swallow it, as occurred in our second patient. Sometimes it may become impacted in nasopharynx and if the event is not witnessed, then it may be neglected. Bilateral rhinorrhea and mouth breathing may lead the physicians to think of more common conditions like adenoid hypertrophy or rhinosinusitis. Cases have been reported where foreign body remained undetected for quite a long period [5], [6].

Nasopharyngeal foreign body should be removed under general anesthesia with the airway secured by an endotracheal tube, rather than have the procedure performed in a sedated child whose airway is unprotected. Successful removal of a foreign body requires visualization and proper instrumentation. Nasal endoscopes help in identification of the foreign body and its removal via nasal route. In case of bigger foreign bodies, a better view is obtained with transnasal soft red rubber catheters brought out of the mouth and clamped to retract the soft palate, and with visualization of the nasopharynx with a laryngeal mirror. Then foreign body can be retrieved through oral route.

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References 

  1. Walby AP. Foreign bodies in the ear or nose. In:  Kerr AG editors. Scott-Brown's Otolaryngology. sixth ed.. Oxford: Butterworth-Heinemann; 1997;p. 6/14/1–6/14/6
  2. Gendeh BS, Gibb AG. An unusual foreign body presenting in the nasopharynx. J. Laryngol. Otol. 1988;102:641–642
  3. Sengupta A, Saha P, Chakrabarty S. Foreign body in the nasopharynx of a child. Ind. J. Otolaryngol. Head. Neck Surg. 2005;57(3):248–249
  4. Oysu C, Yilmaz HB, Sahin AA, Kulecki M. Marble impaction in the nasopharynx following oral ingestion. Eur. Arch. Otorhinolaryngol. 2003;260:522–523
  5. Eghtedari F. Long lasting nasopharyngeal foreign body. Otolaryngol. Head Neck Surg. 2003;129:293–294
  6. Ogut F, Bereketoglu M, Bilgen C, Totan S. A metal ring that had been lodged in a child's nasopharynx for 4 years. Ear. Nose. Throat. J. 2001;80:520–522

PII: S1871-4048(07)00069-X

doi:10.1016/j.pedex.2007.08.005

International Journal of Pediatric Otorhinolaryngology Extra
Volume 3, Issue 1 , Pages 14-16, January 2008

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