JRSM >
Volume 95, Number 12 >
Pp. 614-615
Division of Otorhinolaryngology, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong SAR, China
Correspondence to: Professor William I Wei E-mail: hrmswwi{at}hkucc.hku.hk
Foreign bodies in the nose are common in ear, nose and throat practice. Removal sometimes presents a challenge.
CASE HISTORY
A Chinese man age 19 was referred to our department after an unsuccessful attempt to remove a foreign body from his nose. The history dated back to 2 months previously when the patient had been involved in an argument during dinner. After a series of minor physical contacts (he was not drunk or drugged), a chopstick was noted to be missing. Later, the patient went to the local accident and emergency department where the outer part of a foreign body was removed from below the medial aspect of his right eyelid. The facial wound subsequently healed, but the nose remained uncomfortable with occasional epistaxis.
When the patient reached us, the only obvious external abnormality was a 1 cm scar below the medial aspect of the right lower eyelid. Computed tomography revealed a longitudinal foreign body that had traversed postero-inferiorly from the superior part of the right maxillary antrum, passing through its medial wall, the right nasal cavity and the nasal septum and had lodged in the fossa of Rosenmüller of the left nasopharynx (Figure 1). Endoscopy of the nasal cavities showed the object to be a plastic chopstick. Because the rigid chopstick might have broken if bent (making further retrieval difficult), the plan was to remove it via its path of entry, probably through the anterior wall of the right maxillary sinus. Under general anaesthesia, the facial wound was reopened and a small portion of the anterior wall of the maxilla was removed to expose the broken end of the chopstick. This was then removed intact (Figure 2).
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COMMENT
Foreign bodies in the nose are seen mainly in young children who have inserted them deliberately1,2. Batteries are especially troublesome, because of their erosive effects3. For removal of foreign bodies, general anaesthesia is often desirable to allow endoscopy and insertion of various instruments. In our patient, removal through the nasal cavity was difficult because the chopstick could not safely be bent. The inert nature of the plastic did, however, mean that there was little tissue reaction of the kind that might have complicated its retrieval.
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