Unexpected Nasopharyngeal Foreign Body
Aug 20, 2015
Case Report
Unexpected nasopharyngeal foreign body
Sanjeev Gupta*, Surya Kanta Pradhan
Department of ENT e Head Neck Surgery, Apollo Hospitals, 251, Sainik School Road, Unit-15, Bhubaneswar 751005,
Orissa, India
a r t i c l e i n f o
Article history:
Received 28 September 2013
Accepted 5 November 2013
Available online 23 November 2013
Keywords:
Nasopharynx
Foreign body
Tooth brush
CT-scan
a b s t r a c t
Nasopharynx is a rare area to find a foreign body because of its location and structure. We
are reporting a case of impacted foreign body in nasopharynx in a 13 months old child.
Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.
1. Introduction
Foreign bodies in aerodigestive tract are common entity but in
nasopharynx it’s very rare to find an impacted foreign body
(FB). The anatomical structure of nasopharynx prevents any
lodgement of foreign body. It is capacious and having naso-
pharyngeal sphincter preventing regurgitation of FB from
oropharynx. Through nasal cavity FB cannot travel to naso-
pharynx as the former is narrower. Most of the FB gets
impacted as a result of forceful emesis, coughing, penetrating
trauma or manoeuvre for removal of FB from oropharynx.
2. Case report
A 13 months old male child came to our OPD with complaints
ofmild difficulty in breathing, excessive salivation and nausea
for one day. He was having history of playing with a tooth
brush and he fell down on his face while the brush was inside
the oral cavity. The bristle part of the brush remained inside
and got lost while the remaining part came out. After few
hours he developed the above symptoms and they decided to
take medical help. The local medical practitioner advised for
X-ray neck, chest and abdomen. The FB was not visualised in
the radiograph and he was unable to localise it. After that he
was referred to amedical college where he was examined and
suspected to have FB in bronchus or trachea and referred to us
for removal by bronchoscopy.1
On examination the child was irritable. The vitals were
maintained. Mild respiratory distress was present but with
bilateral normal air entry and no stridor. Ear, nose and throat
were normal on examination. Nasal endoscopy or nasophar-
yngoscopy could not be done as the child was very small and
irritable. We advised for CT Neck with reconstruction sus-
pecting a radiolucent FB in aerodigestive tract. To our surprise
* Corresponding author. Tel.: þ91 8093060206 (mobile).E-mail addresses: [email protected], [email protected] (S. Gupta).
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.elsevier .com/locate /apme
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 1 0e3 1 2
0976-0016/$ e see front matter Copyright ª 2013, Indraprastha Medical Corporation Ltd. All rights reserved.http://dx.doi.org/10.1016/j.apme.2013.11.001
the FB (broken tooth brush) was found to be impacted in the
nasopharynx (Figs. 1 and 2).
Patient was taken for removal of FB under GA. He was
placed in Rose’s position and BoyleseDavis mouth gag
applied. The nasopharynx was approached trans-orally. The
soft palate was retracted upwards by the anterior pillar
retractor. The lower part of the FBwas visualised. It was firmly
stuck in the nasopharynx. It was gently manipulated using a
blunt dissector and the FB was brought into the oropharynx
and then removed without any trauma to nasopharynx. The
nasopharynx was examined using 70 � telescope. As it was a
large FB we did not use nasal endoscope for accessing the FB.
The patient was discharged on the same evening without any
intra-operative or postoperative complications (Fig. 3).
3. Discussion
Foreign body nasopharynx in such a small baby is rare.Most of
the patients present as nasal obstruction, nasal discharge
with or without any breathing or swallowing difficulty but
some remain asymptomatic for a longer period and present
mimicking adenoid hypertrophy and sinusitis.2,3 Most of the
patients can be diagnosed using flexible nasopharyngoscope
or nasal endoscopes.4 In case of a lost FB, radiography should
include X-ray of nasopharynx along with neck, chest and
abdomen.5 Computed tomography and magnetic resonance
imaging could be helpful in selective cases with radiolucent
foreign bodies.
Foreign body in nasopharynx should be kept in mind as a
differential diagnosis in case of a lost FB which may cause
fatal complications if not removed timely. It may dislodge
from the site during coughing, sneezing or manual removal
causing obstruction to larynx and respiratory arrest.
Conflicts of interest
All authors have none to declare.
r e f e r e n c e s
1. Kumar J, Gupta A. Nasopharyngeal foreign body in a youngchild. Indian J Otorhinolaryngol. 2011;63(3):285e286.
Fig. 1 e CT-scan showing impacted brush in the
nasopharynx.
Fig. 2 e 3D reconstruction of CT-scan showing brush below
base of skull.
Fig. 3 e Brush head after removal.
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 1 0e3 1 2 311
2. Oysu C, Yilmaz HB, Sahin AA, Kulekci M. Marble impaction inthe nasopharynx following oral ingestion. Eur ArchOtorhinolaryngol. 2003;260:522e523.
3. Eghtedari F. Long lasting nasopharyngeal foreign body.Otolaryngol Head Neck Surg. 2003;129(3):293e294.
4. Singh RK, Varshney S, Bist SS, Gupta N. A rare nasopharyngealforeign body. Online J Health Allied Sci. 2008;7(1):10.
5. Parker AJ, Bingham BJ, Osborne JE. The swallowed foreignbody. Is it in the nasopharynx? Postgrad Med J. 1988;64:201e203.
a p o l l o m e d i c i n e 1 0 ( 2 0 1 3 ) 3 1 0e3 1 2312
Apollo hospitals: http://www.apollohospitals.com/Twitter: https://twitter.com/HospitalsApolloYoutube: http://www.youtube.com/apollohospitalsindiaFacebook: http://www.facebook.com/TheApolloHospitalsSlideshare: http://www.slideshare.net/Apollo_HospitalsLinkedin: http://www.linkedin.com/company/apollo-hospitalsBlog:Blog: http://www.letstalkhealth.in/