Management of an Unusual Intranasal Foreign Body Abutting the Cribriform Plate: A Case Report and Review of Literature

A 35-year-old man with history of schizophrenia presented 3 weeks after placing a screw in his right nostril. Initial imaging showed a screw in the right ethmoid sinus with the tip penetrating the right cribriform plate. On exam, the patient was hemodynamically stable with purulent drainage in the right nasal cavity but no visible foreign body. While most nasal foreign bodies occur in children and are generally removed at the bedside, intranasal foreign bodies in adults tend to require further assessment. The foreign body in this case was concerning for skull base involvement and the patient was brought to the operating room (OR) with neurosurgery for endoscopic sinus surgery (ESS) and removal of foreign body. The screw was removed and the patient recovered with no signs of cerebrospinal fluid (CSF) leak postoperatively. Any concern for skull base or intracranial involvement should call for a full evaluation of the mechanism of injury and intervention in a controlled environment.

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Laryngo-tracheo-bronchial foreign bodies in children

The Journal of Laryngology & Otology ◽

10.1017/s0022215100107170 ◽

1988 ◽

Vol 102 (11) ◽

pp. 1029-1032 ◽

Cited By ~ 78

Author(s):

Amit Banerjee ◽

K. S. V. K. Subba Rao ◽

S. K. Khanna ◽

P. S. Narayanant ◽

B. K. Gupta ◽

...

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Bronchial Tree ◽

Endoscopic Removal ◽

Diagnosis And Management ◽

Respiratory Passage ◽

History Of ◽

The Right

AbstractInhalation of a foreign body into the respiratory passage can be a serious and sometimes fatal childhood accident. In this paper we analyze the management of 223 children with laryngo-tracheo-bronchial foreign bodies. Children below three years of age were found to be the most vulnerable. The majority of the patients were boys. Over a quarter of the patients did not present with a history of inhalation. Only 52 per cent reported within 24 hours of inhalation. Endoscopic removal was possible in all but nine cases. One hundred and fort eight (66.4 per cent) of the recovered foreign bodies were organic in origin, the majority of them being peanuts. In one hundred and five (47.1 per cent) the objects found their way into the right bronchial tree. There were two deaths. The modalities of diagnosis and management are discussed.

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Tendency to Ingest Foreign Bodies in Mentally Retarded Patients: A Case with Ileal Perforation Caused by the Ingestion of a Teaspoon

Case Reports in Surgery ◽

10.1155/2016/8075432 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3

Author(s):

İhsan Yıldız ◽

Yavuz Savaş Koca ◽

Gökhan Avşar ◽

İbrahim Barut

Keyword(s):

Mental Retardation ◽

Foreign Body ◽

Foreign Bodies ◽

Mentally Retarded ◽

The Body ◽

Foreign Body Ingestion ◽

Emergency Laparotomy ◽

Ileal Perforation ◽

History Of ◽

The Right

Introduction. Unintentional foreign body ingestion commonly occurs accidentally in children aged between 3 months and 6 years and at advanced ages or results from psychiatric disorders such as hallucination in patients with mental retardation. Most of the ingested foreign bodies are naturally discharged from the body but some of them may require surgical intervention.Presentation of Case. A 29-year-old mentally retarded female patient was admitted to the emergency service with a two-day history of abdominal pain, nausea, and vomiting. Physical examination revealed abdominal tenderness, defense, and rebound on palpation. Radiological examination revealed diffuse air-fluid levels and a radiopaque impression of a metal object in the right upper quadrant. The metal teaspoon causing ileal perforation was extracted by emergency laparotomy. On postoperative day 7, the patient was uneventfully discharged following a psychiatric consultation.Discussion. Foreign body ingestion can occur intentionally in children at developing ages and old-age patients, or adults and prisoners, whereas it may occur unintentionally in patients with mental retardation due to hallucination. However, repeated foreign body ingestion is very rare in individuals other than mentally retarded patients.Conclusion. Mentally retarded patients should be kept under close surveillance by surgeons and psychiatrists due to their tendency to ingest foreign bodies.

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A Rare Case of Chronic Intracerebral Foreign Body

Green Medical Journal ◽

10.33096/gmj.v2i1.34 ◽

2020 ◽

Vol 2 (1) ◽

pp. 18-23

Author(s):

Naufal Hilmy Imran ◽

Wahyudi

Keyword(s):

Foreign Body ◽

Foreign Bodies ◽

Gunshot Wounds ◽

Anatomical Location ◽

Major Injury ◽

Left Limb ◽

Foreign Body Extraction ◽

History Of ◽

Motor Strength ◽

The Right

Introduction: Intracranial foreign bodies are usually caused by trauma that penetrates the cranium. Gunshot wounds are the most common cause, while non-missile intracranial penetration is rare. The patient’s clinical condition highly depends on the mechanism, anatomical location of the lesion, and related injuries. Possible complications include intracerebral hemorrhage, contusion, major injury on the vascular, and meningitis. In this article, we report case of intracerebral nail extraction from a patient with right cerebral foreign body. Case presentation: A 22-year-old man with a history of unspecified schizophrenia reported with reduced awareness accompanied by weakness of his left limb. During a head CT scan of the head, there are several tubular foreign bodies in the right cerebral. Craniotomy for foreign body extraction and drainage of the cerebral abscess is immediately performed. Four days after surgery, the patient had increased awareness, although there was no significant improvement in motor strength. One month after discharged from hospital there was slight improvement in motor strength. Conclusion: Extraction of foreign bodies by a surgical procedure is mandatory and should be performed thoroughly. The administration of antibiotics, anticonvulsants, physiotherapy, and psychiatric follow-up should be added to the treatment of this patient.

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Migration of a Swallowed Blunt Foreign Body to the Neck

Case Reports in Otolaryngology ◽

10.1155/2014/646785 ◽

2014 ◽

Vol 2014 ◽

pp. 1-2

Author(s):

Kerem Ozturk ◽

Goksel Turhal ◽

Sercan Gode ◽

Atilla Yavuzer

Keyword(s):

Computed Tomography ◽

Foreign Body ◽

Primary Closure ◽

Foreign Bodies ◽

Barium Swallow ◽

X Rays ◽

Upper Aerodigestive Tract ◽

Computed Tomography Scans ◽

History Of ◽

The Right

Ingestion of foreign bodies is a common problem in the otolaryngology practice. Reports of extraluminal migration of the foreign bodies from the upper aerodigestive tract are rare. Penetration and extraluminal migration of ingested foreign bodies may cause severe vascular and suppurative complications, even death. We report a 4-year-old girl who presented with a mass and partial extrusion of a foreign body in the neck. She had a history of ingesting the plastic top piece of a knitting needle approximately 1 year ago. She had been asymptomatic until the present time. The examination revealed a red, blunt, rectangular plastic foreign body half embedded in the skin of the right neck. Esophagography with barium swallow, cervical X-rays, and computed tomography scans were obtained. The foreign body was easily removed under general anesthesia. Primary closure and direct laryngoscopy was also performed. The patient recovered very well without any complications.

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Prolonged Implantation of Sinus Devices and Implications for Chronic Rhinosinusitis: A Case Report and Review of the Literature

Surgical Case Reports ◽

10.31487/j.scr.2020.04.10 ◽

2020 ◽

pp. 1-4

Author(s):

Charles S. Ebert Jr. ◽

Adam J. Kimple ◽

Adam M. Zanation ◽

Brian D. Thorp ◽

Charles S. Ebert Jr. ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Medical Management ◽

Endoscopic Sinus Surgery ◽

Foreign Bodies ◽

Scar Tissue ◽

Sinus Surgery ◽

Prior Surgery ◽

History Of ◽

Routine Observation ◽

The Right

Background: Implantation of sinus stents and spacers can be used as adjuvant management to maintain patency of sinuses after endoscopic sinus surgery for chronic rhinosinusitis. These implants are typically removed several weeks after surgery. We present two cases of different patients who were initially treated by different physicians and were found to have retained sinus spacers in their paranasal sinuses 6-10 years after implantation. Case Presentation: Case 1: A 40-year-old male with chronic rhinosinusitis and history of balloon sinuplasty six years prior presented with worsening symptoms of chronic rhinosinusitis refractory to medical management. He underwent revision functional endoscopic sinus surgery and was found to have retained sinus implants in the left and right frontal sinus recesses. Case 2: A 48-year-old female with long-standing chronic rhinosinusitis refractory to medical management presented after two prior sinus surgeries most recently 10 years ago. She underwent revision functional endoscopic surgery and was found to have a retained sinus implant from prior surgery in the right frontal recess outflow tract embedded within scar tissue and reactive hyperostosis. Foreign bodies from both patients were removed without complication and patients were healing appropriately in the post-operative period. Conclusions: While sinus stents and spacers can help with post-operative scarring, leaving then unmonitored and in place will eventually result in them becoming a nidus for scarring and infection. It is critical that patients are aware of any foreign bodies we place, if they need scheduled removal or routine observation, and what symptoms may indicate that they are causing a problem.

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Foreign Body of the Right Nostril and Left Bronchus

PEDIATRICS ◽

10.1542/peds.59.2.303 ◽

1977 ◽

Vol 59 (2) ◽

pp. 303-304

Author(s):

Donald B. Hawkins ◽

Emily J. Kahlstrom ◽

Eithne F. MacLaughlin ◽

Monique F. Margetis

Keyword(s):

Case Report ◽

Foreign Body ◽

Los Angeles ◽

Los Angeles County ◽

Foreign Bodies ◽

Medical Center ◽

University Of Southern California ◽

Left Bronchus ◽

History Of ◽

The Right

Foreign bodies in the airway often present problems for physicians who treat children. The following case report illustrates some of these problems. CASE REPORT A 6-year-old boy was admitted to the Pediatric Respiratory Disease Service of the Los Angeles County-University of Southern California Medical Center with a complaint of persistent nonproductive cough since awakening the morning of the previous day. He also had a history of discharge from his right nostril for eight months, at times foul-smelling. During this time, he had seen doctors on three occasions; twice antibiotics had been prescribed for sinus infection. He was in no distress, and demonstrated no respiratory difficulty.

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Computed tomographic Assessment of Lateral Lamella of Cribiform Plate and Comparison of Depth of Olfactory Fossa

Journal of Nepal Medical Association ◽

10.31729/jnma.104 ◽

2010 ◽

Vol 49 (178) ◽

Cited By ~ 3

Author(s):

M Bista ◽

M Maharjan ◽

S Shrestha ◽

T KC

Keyword(s):

Skull Base ◽

Endoscopic Sinus Surgery ◽

Cribriform Plate ◽

Sinus Surgery ◽

Tomographic Images ◽

Medical College ◽

Computed Tomographic ◽

Diagnostic Center ◽

The Right ◽

Median Height

INTRODUCTION: Endoscopic sinus surgery is an upcoming branch in rhinological practice but with some major risks since it has to play around the skull base area. Lateral lamella of cribriform plate is the thinnest area of the skull base. Thus this study is undertaken to evaluate the height of lateral lamella of cribriform plate and the depth of olfactory fossae by the help of computed tomographic images. METHODS: Computed tomographic study of 50 patients was done in Advanced Imaging and Diagnostic center, Kathmandu Medical College. Coronal sections at the centre of infra-orbital foramina were taken as reference slide. The height of cribriform plate point was subtracted from the height of medial ethmoidal roof point to measure the length of lateral lamella of cribriform plates on both sides. RESULTS: The median height of LLCP in 100 slides was 2.8 mm. LLCP height was 0 to 3.9 mm in 86 slides, 4 to 7 mm in 12 slides and greater than 7mm in 2 slides. The LLCP length was greater in right side in 28 (56%) patients and was greater in left side in 19 (38%) patients. It was equal in both sides in only three patients (6%). CONCLUSIONS: As regards the length of LLCP; 0 to 3.9 mm length was most common. The olfactory fossa depth was more in the right side compared to the left side. Thus, right side is more vulnerable to injury during surgery. Thus adequate caution has to be exercised by the rhinological surgeon during endoscopic sinus surgery. Keywords: lateral lamella of Cribriform plate, medical ethmoidal roof, olfactory fossa.

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Anatomic Variations of Ethmoid Roof and Risk of Skull Base Injury in Endoscopic Sinus Surgery: Statistical Correlations

American Journal of Rhinology and Allergy ◽

10.1177/19458924211020549 ◽

2021 ◽

pp. 194589242110205

Author(s):

Gian Luca Fadda ◽

Alessio Petrelli ◽

Federica Martino ◽

Giovanni Succo ◽

Paolo Castelnuovo ◽

...

Keyword(s):

Skull Base ◽

Endoscopic Sinus Surgery ◽

Horizontal Plane ◽

Uncinate Process ◽

Cribriform Plate ◽

Sinus Surgery ◽

Evaluation Methodology ◽

Anatomic Variations ◽

Imaging Evaluation ◽

Plane Passing

Background Recent developments in endoscopic sinus surgery (ESS) have increased the need to investigate the complex anatomic variations in the ethmoid roof and skull base, to inform the surgeon about the risk of damaging these crucial areas during ESS. Objective To offer a detailed description of sinus anatomy focusing on the key surgical landmarks in ESS and frontal recess surgery to standardize a systematic approach during the preoperative sinuses imaging evaluation. Methodology: A total of 220 computed tomography (CT) scans were reviewed to obtain six sets of measurements: the depth of the cribriform plate (CP); the length of the lateral lamella of the cribriform plate (LLCP); the angle formed by the LLCP and the continuation of the horizontal plane passing through the CP; the position of the anterior ethmoidal artery (AEA) at the skull base; the extent of frontal sinus pneumatization (FSP); the type of superior attachment of the uncinate process (SAUP). Results The length of the LLCP was statistically significantly correlated with the different Keros classification types, the angle formed by the LLCP with the continuation of the horizontal plane passing through the CP, and with the AEA position at the skull base. The depth of the olfactory fossa was correlated with FSP. Conclusions According to the Keros and Gera classifications, the data obtained from these evaluations allow the assessment of anatomic-radiological risk profiles and can help identify those patients who are high risk for ethmoid roof injury.

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Endobronchial Foreign Body Presenting as Exacerbation of Asthma

Case Reports in Emergency Medicine ◽

10.1155/2017/6863083 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

James E. Tsang ◽

June Sun ◽

Gaik C. Ooi ◽

Kenneth W. Tsang

Keyword(s):

Foreign Body ◽

Respiratory Distress ◽

Foreign Bodies ◽

Main Bronchus ◽

Fiberoptic Bronchoscopy ◽

Clinical History ◽

Medical Personnel ◽

History Of ◽

Normal Chest ◽

Low Dose Computed Tomography

Airway foreign bodies are a leading cause of death among children and require urgent recognition by medical personnel. While most cases are diagnosed readily from a clinical history of acute respiratory distress, some cases remain more indolent and present later. We report the case of a 7-year-old boy who aspirated a “LEGO” toy and presented with a week history of increasing respiratory distress compatible with known asthma. Despite a normal chest X-ray, a low-dose computed tomography showed the presence of a foreign body in the left main bronchus, which was subsequently removed by fiberoptic bronchoscopy. Our case serves to reemphasize the importance of considering airway foreign bodies as a cause of respiratory distress, especially in young children.

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Pneumocephalus and CSF leak secondary to skull base fracture by pyrotechnical object: case report

Peruvian Journal of Neurosurgery ◽

10.53668/2021.pjns33175 ◽

2021 ◽

Vol 3 (3) ◽

Author(s):

Marcos Vilca ◽

◽

Carlos Palacios ◽

Sofía Rosas ◽

Ermitaño Bautista ◽

...

Keyword(s):

Cerebrospinal Fluid ◽

Intracranial Pressure ◽

Skull Base ◽

Rare Complication ◽

Cerebrospinal Fluid Leak ◽

Standing Position ◽

Csf Leak ◽

Skull Base Fracture ◽

Timely Diagnosis ◽

The Right

Introduction: Pneumocephalus is mainly associated with traumatic injuries, being a rare complication but with high mortality rates; it behaves like a space-occupying lesion and increases intracranial pressure. The symptoms are not specific, but in the event of trauma it is necessary to suspect this entity to carry out a timely diagnosis and treatment, since being the product of the skull base fracture it can cause communication with the outside, and the appearance of cerebrospinal fluid (CSF) leak. Clinical Case: a 38-year-old male patient who suffers trauma from a pyrotechnic explosion near his right ear, when handling a pyrotechnic object (whistle) during the New Year, presenting severe pain, slight bleeding in the right ear, feeling faint and holocranial headache that increased in a standing position; likewise, he presents high-flow aqueous secretion (CSF) from the right ear. Brain and skull base tomography (CT) showed air in the intracranial cavity, fracture of the skull base, and the ossicles of the right middle ear. Conservative management was performed using rest and lumbar drainage, presenting a satisfactory evolution. Conclusion: Pneumocephalus is a frequent and expected complication of trauma with a skull base fracture. Its early and timely diagnosis using skull base CT is essential to define therapeutic measures. Accidents due to the misuse of pyrotechnics continue to be a relevant problem in our country. Knowing and disseminating its consequences can help raise awareness in the population. Keywords: Pneumocephalus, Skull Base, Intracranial Pressure, Cerebrospinal Fluid Leak. (Source: MeSH NLM)

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