Long-standing intranasal foreign body: an incidental finding on dental radiograph: a case report and literature review

Unexpected metallic foreign bodies on panoramic scans - a narrative review

BACKGROUND

The digital panoramic radiograph (orthopantomogram, OPG) is the standard radiographic technique for basic diagnostics in dental practice. A correctly taken image provides a good overview of teeth and jaw, whereas radiopaque foreign materials, e. g. metal, can obscure relevant findings.

METHODS

A literature review on unexpected metallic foreign bodies in OPG was performed to determine the spectrum of metallic foreign bodies that may cause radiopaque areas on panoramic radiographs in routine clinical use.

RESULTS AND CONCLUSION

A total of 37 different unexpected metallic foreign bodies were found. They can be categorized as jewelry, clothing, personal protective equipment, medical devices, iatrogenic foreign bodies, and rare incidental findings. Radiopaque foreign materials in the OPG are often relatively easy to recognize as artifacts because of their location, and they are avoidable in most cases. If unclear, a three-dimensional radiograph was helpful for determining the location. Radiopaque areas caused by foreign bodies can lead to misinterpretation or partial or complete non-evaluability and should therefore be avoided.

KEY POINTS

· The OPG is the standard radiograph for dentists, oral surgeons, and oral and maxillofacial surgeons.. · Foreign bodies made of metal can lead to non-evaluability of panoramic radiographs. Based on a review of the literature and exemplary radiographs, this article provides an overview of rare but typical metallic foreign bodies in OPG, thus addressing the problem of the subfield of radiography by making radiologists more familiar with these images.. · The spectrum of unexpected metallic foreign bodies includes unremoved earrings with the typical ghost images on the contralateral side, piercings, hearing aids, acupuncture needles, rare iatrogenic foreign bodies, incidental findings in infants in the nose and external auditory canal, vascular clips after surgical interventions, and ritual subcutaneous foreign materials..

CITATION FORMAT

· Brauer HU, Bartols A, Hellmann D et al. Unexpected metallic foreign bodies on panoramic scans - a narrative review. Fortschr Röntgenstr 2023; 195: 809 - 818.

A case of foreign bodies self-inserted into the paranasal sinus via an oroantral fistula

Foreign bodies in the nasal cavity are rarely seen in adults, and most cases are traumatic in origin. Multiple foreign bodies in adults are particularly rare. Foreign bodies induce pain, bleeding, and infection but are easily removed in most cases. A patient presented with multiple toothpick foreign bodies in the nasal cavity, which were introduced intentionally through an oroantral fistula. We report an adult case with 37 toothpicks in the nasal cavity, which were removed successfully with a nasal endoscope. Oroantral fistula closure was achieved through oral surgery. Voluntary insertion of foreign bodies into the body by patients with mental illnesses is relatively difficult to identify. Evaluating and managing the psychiatric problems of such patients during treatment planning are necessary.

Nasopharyngeal foreign body triggered by a blind finger sweep

A previously healthy 1-year-old boy suddenly began choking and coughing after ingesting a coin. The child's mother attempted to extract the coin by inserting her fingers in his mouth and sweeping the oral cavity. The mother felt the object momentarily with her fingertips but was unable to retrieve it, and brought her son to a local hospital for assistance. The patient was referred to our emergency department (ED) for possible oesophageal obstruction by a foreign body based on the X-ray findings. On arrival at our ED, the child exhibited mild gagging but presented no respiratory symptoms and normal pulmonary examination. The chest X-ray revealed a nasopharyngeal foreign body. The patient was placed under procedural sedation and emergency removal was successfully completed by an otolaryngologist. Subsequently, the patient was discharged without complications.

An incidental finding of a long-standing button battery in the floor of the nose during a routine orthodontic examination

Foreign body insertion into the ears and nose is common in children and is often witnessed by the carer or reported by the child and therefore appropriate management can be sought promptly. However, these incidents can go unreported and may be accompanied by non-specific symptoms making diagnosis difficult. Button batteries are common in everyday life and their small size and shiny appearance make them appealing to children and their ingestion or insertion is not uncommon. Due to their size, shape and electrochemical composition button batteries pose serious complications if ingested, inhaled or inserted. In the nose they usually cause intense local tissue reactions resulting in severe tissue destruction, septal necrosis or stenosis of the nasal cavity as well as posing the risk of subsequently being ingested or aspirated. This case report details an incidental finding of a button battery in the floor of the nose discovered on routine orthodontic radiographs. An upper standard occlusal and dental panoramic tomography showed a radiopaque, cylindrical, object in the floor of the nose which a subsequent CBCT localized to the floor of the right nasal fossa. The patient required orthodontic extractions and the exposure and bonding of teeth under general anaesthetic. Therefore the battery was removed by the maxillofacial surgery team at the same general anaesthetic. This is a rare case of an incidental finding of a long-standing button battery impaction which was asymptomatic and did not have any detrimental effects. This case highlights the dangers of button battery impaction and the need for prompt referral for removal.

Assessment of migrated foreign bodies in the maxillae by x-ray fluorescence spectrometry

Two cases of foreign bodies that were incidentally observed on orthopantomographs are reported in this study. The foreign bodies were analyzed using an x-ray fluorescence spectrometer to identify what the migrated foreign bodies were and what migration pathways they had taken. The removed metallic foreign bodies from the maxillae of 2 patients, who were referred to the Department of Dentistry and Oral Surgery of the University of Fukui Hospital, were analyzed using an x-ray fluorescence spectrometer in the Department of Dental and Biomedical Materials Science, Nagasaki University. The major component of foreign body in patient 1 was silver, and that in case 2 was iron. On the basis of the imaging results and the patients' clinical history, the foreign bodies were considered to be caused by iatrogenic migration. Understanding the existence of foreign bodies and their migration pathway into the jaw bone can thus make clinicians more aware of such migrations and can thereby contribute to reducing iatrogenic accidents.

Unusual foreign body in the nasal cavity of an adult with repaired cleft lip and palate

Intranasal foreign bodies arising from dental clinical practice, especially in patients with cleft lip and palate (CLP) occur rarely and are very scarce in the literature. This article reports an unusual case of a dental impression material presenting as a foreign body in the nasal cavity of an adult with repaired CLP who presented for dental prosthetic rehabilitation. To our knowledge, this is only the second report presenting nasal foreign body in a cleft patient arising due to a dental impression procedure.

Multiple Intranasal Foreign Bodies: An Incidental Diagnosis

Inquisitive children often insert foreign bodies into their nose or other body orifices while they explore their own bodies in early childhood. Intranasal foreign bodies are found in children, most commonly in 2-4 years olds.

Common symptoms in such cases include pain or discomfort, nasal discharge, nasal congestion, nasal odor, including bromhidrosis (foul body odor). Complications, such as facial cellulitis, epiglottitis, and cephalic tetanus have also been reported. Mentally challenged children may be at a higher risk for such foreign body insertion and may need to be examined at regular intervals.

Careful interpretation of dental radiographs can go a long way in diagnosing such cases especially in the absence of a positive history. Radiolucent objects are more difficult to identify especially in the absence of a positive history, and hence their diagnosis and removal is more challenging for the clinician.

Dental practitioners can play a significant role in the diagnosis of intranasal foreign bodies in children through careful clinical examination and interpretation of dental radiographs.

This case report describes a child referred for dental care and a diagnosis of intranasal foreign body was made based on routine dental panoramic radiograph.

An unusual foreign body as cause of chronic sinusitis: a case report

INTRODUCTION

The presence of a foreign body in the nose is a relatively uncommon occurrence. Many unusual foreign bodies in the nose have been reported in the literature, but no case of a nasal packing occurring as a foreign body in the nasal cavity for a prolonged time has been found.

CASE PRESENTATION

We describe a unique case of the largest foreign body left in situ in the nasal cavity for over 10 years. Our patient was a 71-year-old Caucasian man with diabetes. Because of this, he was at high risk of developing complications from the foreign body and the chronic sinusitis. Amazingly, though, the foreign body had not caused any symptoms on our patient for many years, except for nasal discharge during the last few years. To the best of our knowledge, this is the first case in the literature of such a large intra-nasal foreign body described in an adult without mental illness and without trauma that remained in situ for such a long time.

CONCLUSION

Undoubtedly, even illnesses with no complications could prove difficult for clinicians to diagnose. Clinicians should recognize the underlying causes that are responsible for the symptoms of chronic sinusitis and a unilateral nasal discharge should be assumed to be caused by an intra-nasal foreign body until proven otherwise.

Paediatric aerodigestive foreign bodies: remember the nasopharynx

INTRODUCTION

Nasopharyngeal foreign bodies are relatively uncommon, compared with other aerodigestive sites. They may mimic a lower airway location, or may be coughed up into the nasopharynx prior to endoscopic evaluation.

OBJECTIVE

To describe our experience with nasopharyngeal foreign bodies mimicking a more distal airway location.

METHOD

Case series from a tertiary referral children's hospital.

RESULTS

We present a series of four children who were initially thought to have a lower aerodigestive tract foreign body (three respiratory, one oesophageal), but who were finally diagnosed with nasopharyngeal foreign body. The concept of panendoscopy at all foreign body removals is suggested as a means to avoid a missed nasopharyngeal foreign body.

CONCLUSION

Although nasopharyngeal foreign bodies are uncommon, their rare ability to mimic distal sites mandates a thorough endoscopic approach to ensure that all sites (i.e. larynx, lungs, oesophagus and nasopharynx) are evaluated endoscopically.

Overlooked nasal foreign body with a 48-year latent period

Foreign bodies of the nose are relatively frequent in pediatric population, while in the adults, they are usually seen in disturbed persons. Overlooked nasal foreign bodies may be singled out as a special entity. They become rhinolites over time with latent period of several decades. Our paper illustrates an overlooked foreign body in the nose--i.e. encrusted plastic bead which, after the asymptomatic period of 48 years, induced the unilateral mucopurulent and ichorous secretion from the nose. Rhinolite should be suspected if radiological diagnostics detected calcified mass in the nose together with unilateral nasal symptomatology. Surgical removal of rhinolite results in complete management of such problem. This case indicates the significance of medical history data and examination of nasal cavity in any adult patient with unilateral nasal symptomatology which is refractory to conservative treatment. Computerized tomography of paranasal sinuses is an important adjunct diagnostic tool in indefinite cases. Nevertheless, it often happens that only the extraction of rhinolite indicates the diagnosis that is not usually suspected in adult persons.

Removal of a metallic foreign body embedded in the external nose via open rhinoplasty approach

Most metallic foreign bodies are inert, but they can cause chronic inflammatory reactions and be a source of infection. Identification and removal of foreign bodies from wounds is often necessary. The present report describes two cases of a foreign body embedded in the external nose. Each case was successfully treated by an open rhinoplasty approach. This approach is an effective and safe method for removal of foreign bodies in the external nose. It provides a good surgical field and a better cosmetic outcome than a conventional incision.

Unusual foreign body in the nasal cavity

Foreign objects frequently have been reported in the nasal structures, often these foreign bodies are occasionally inhaled by children or they are often inserted in nasal cavities after various accidents. Frequently, the presence of foreign bodies in the nose represents an emergency, particularly for pediatric patients where the incidence is high. The report in this article described an unusual nasal foreign body in an adult discovered incidentally during a cranial radiography. This report is an unusual case of facial asymmetry caused by a foreign nasal body in adult, which is destitute of complications, connected to long-term presence of the intranasal button. The finding was accidental; moreover the patient was an adult and did not present a clear symptomatology. Through careful clinical and fibroscopy exam, valuating also the site of the foreign body, it is necessary an intranasal surgery treatment. The results of the treatment is connected to a combined use of different branches of learning with the aim of obtaining positive results from both a clinical and legal point of view.

Nasal foreign bodies in children: a possible pitfall for the anesthesiologist

Based on a recent surprising case in our institution, we analyze the possible dislodgment of an unknown foreign body in the nose during nasotracheal intubation in children. Nasal foreign bodies made of inert material can remain unnoticed for a long period of time. In addition to inserting a close-fitting suction catheter into the TT during its passage through the nasopharynx, we now suggest performing a pharyngoscopy when intubation is completed.

An unusual intranasal foreign body in an unsuspecting 9-year old

This report describes the incidental finding and removal of an unusual intranasal foreign body in a 9-year-old boy. The spectrum of items lost and found in the nasal cavity are reviewed before discussing the management of this case. Dental Practitioners should remain vigilant as radiopaque foreign bodies can be identified on commonly taken dental radiographic views. Patients should be referred promptly for foreign body removal in order to minimize potential complications.