An unusual foreign body (Big Metallic Nut) in the nasopharynx of an infant

Nasopharynx- The Secret Vault for Lost Foreign Bodies of the Upper Aerodigestive Tract

INTRODUCTION

Foreign bodies in the upper aerodigestive tract often get lost following inappropriate attempts at removal. Children may present late with localized infection, posing a challenge to the otolaryngologists in a referral set-up in diagnosing and retrieving such foreign bodies.

CASE REPORT

A two-year-old boy presented with refractory purulent rhinorrhea and intermittent low-grade fever. The symptoms suggested rhinosinusitis; however, following a high index of suspicion, he was referred for further evaluation, with the possibility of any hidden foreign object in the upper aerodigestive tract. His soft palate appeared bulged, and his mother informed that he had ingested the cap of a plastic bottle about a month back which could not be retrieved despite several attempts by her. X-ray of soft tissue nasopharynx revealed a radiolucent shadow of a round object resulting in palatal bulging. It was eventually removed by combined endoscopic/transoral approach.

CONCLUSION

In a child with a lost foreign body, the nasopharynx should be meticulously explored. This is less common for ingested objects compared to inhaled ones. The diagnosis becomes furthermore challenging when it is not radio-opaque. Naïve manipulations must be avoided and prompt referral should be made to the otolaryngologists for guided removal and minimizing complications.

Nasal Foreign Body, Dislodged and Lost - Can the Adenoids Help?

Foreign body in the nasal cavity is one of the most common paediatric otolaryngology emergencies and needs to be promptly addressed. The incidence of nasal foreign body getting dislodged secondary to unsuccessful attempts to take it out is quite high and can be potentially dangerous as it might cause fatal airway compromise. The chances of it getting impacted and retained in the nasopharynx are practical, although such cases are seldom encountered for primarily nasal foreign bodies. Nevertheless, the nasopharynx should always be looked for as a site of impaction of hidden foreign objects. Presence of enlarged adenoids could be of help as it may prevent accidental lodgement of displaced foreign body in the airway, but might also result in difficulty in locating and retrieving the foreign body because it acts as an anchor-pad with its grooves and crevasses. This report presents a rare, interesting case of a child with enlarged adenoids anchoring a metallic ring and describes the clinical presentations and relevant management of a nasal foreign body dislodged and lost in the nasopharynx.